Basic Information
| Provider Information | |||||||||
| NPI: | 1073012084 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | O'BLENNESS | ||||||||
| FirstName: | TENNILLE | ||||||||
| MiddleName: | SUZANNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4627 | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992200627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096241244 | ||||||||
| FaxNumber: | 5096246240 | ||||||||
| Practice Location | |||||||||
| Address1: | 2308 W 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992015810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096241244 | ||||||||
| FaxNumber: | 5096246240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2018 | ||||||||
| LastUpdateDate: | 02/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CP60313150 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.