Provider Demographics
NPI:1730740168
Name:FREDERICK- MAUPIN, TAMI (CDPT)
Entity type:Individual
Prefix:
First Name:TAMI
Middle Name:
Last Name:FREDERICK- MAUPIN
Suffix:
Gender:F
Credentials:CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-9014
Mailing Address - Country:US
Mailing Address - Phone:360-809-4269
Mailing Address - Fax:
Practice Address - Street 1:390 E CEDAR ST
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3403
Practice Address - Country:US
Practice Address - Phone:360-681-8463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60955723101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)