Provider Demographics
NPI:1295881316
Name:MYERS, TAMMIE LYNN (CDP)
Entity type:Individual
Prefix:MS
First Name:TAMMIE
Middle Name:LYNN
Last Name:MYERS
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19500 82ND PL W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-6208
Mailing Address - Country:US
Mailing Address - Phone:206-510-5785
Mailing Address - Fax:
Practice Address - Street 1:9227 232ND ST SW
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-5025
Practice Address - Country:US
Practice Address - Phone:206-510-5785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00004994101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)