Basic Information
| Provider Information | |||||||||
| NPI: | 1174924823 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLANAGIN | ||||||||
| FirstName: | TANYA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11304 124TH AVE NE UNIT 301 | ||||||||
| Address2: | |||||||||
| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980334630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065483114 | ||||||||
| FaxNumber: | 2067626355 | ||||||||
| Practice Location | |||||||||
| Address1: | 11304 124TH AVE NE UNIT 301 | ||||||||
| Address2: | |||||||||
| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980334630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064227119 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2014 | ||||||||
| LastUpdateDate: | 02/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LH60976499 | WA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | MC60459609 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.