Provider Demographics
NPI:1487450870
Name:HEADLEY, ARIANNA-MYCHELLE RAE
Entity type:Individual
Prefix:
First Name:ARIANNA-MYCHELLE
Middle Name:RAE
Last Name:HEADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5028 S TYLER ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-1907
Mailing Address - Country:US
Mailing Address - Phone:541-720-6207
Mailing Address - Fax:
Practice Address - Street 1:950 BROADWAY STE 301
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4454
Practice Address - Country:US
Practice Address - Phone:253-292-4354
Practice Address - Fax:855-373-4004
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst