MEDICARE: DARREN WENZ

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	251S00000X	Community/Behavioral Health Agency	LW60185893	WA

General Provider Information

NPI Number	:	1174912034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DARREN WENZ

Provider Business Mailing Address
First Line	:	1451 MOORLANDS DR
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98405-1158
Country	:	US
Telephone Number	:	253-282-5302
Fax Number	:

Provider Business Practice Location Address
First Line	:	2002 65TH AVE W
Second Line	:
City	:	FIRCREST
State	:	WA
Zip	:	98466-6200
Country	:	US
Telephone Number	:	253-566-5559
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL SOCIAL WORKER
Name	:	DARREN P WENZ
Credential	:	LICSW
Telephone Number	:	253-282-5302

Provider Enumeration Date	:	01/15/2015
Last Update Date	:	01/15/2015

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