Basic Information
| Provider Information | |||||||||
| NPI: | 1720596844 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POZNEKOFF | ||||||||
| FirstName: | TATIANA | ||||||||
| MiddleName: | LYN | ||||||||
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| Credential: | CADC 1 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2830 SW 153RD DR | ||||||||
| Address2: | |||||||||
| City: | BEAVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970035123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038869797 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10362 SW MCDONALD ST | ||||||||
| Address2: | |||||||||
| City: | TIGARD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972244863 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036240312 | ||||||||
| FaxNumber: | 5036393973 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2018 | ||||||||
| LastUpdateDate: | 01/11/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 171018 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.