MEDICARE: PETIA SIERSCHYNSKI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MHCA.MC.61662933	WA

General Provider Information

NPI Number	:	1164255170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETIA SIERSCHYNSKI

Provider Business Mailing Address
First Line	:	9116 GRAVELLY LAKE DR SW STE 107
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-3148
Country	:	US
Telephone Number	:	253-256-5415
Fax Number	:

Provider Business Practice Location Address
First Line	:	9116 GRAVELLY LAKE DR SW STE 107
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-3148
Country	:	US
Telephone Number	:	253-256-5415
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2024
Last Update Date	:	01/15/2026

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