Healthcare Provider Details

I. General information

NPI: 1861884470
Provider Name (Legal Business Name): TANYA ELAINE STEPHENSON LICSW, SUDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4238 AUBURN WAY N
AUBURN WA
98002-1311
US

IV. Provider business mailing address

19620 96TH ST E
BONNEY LAKE WA
98391-8441
US

V. Phone/Fax

Practice location:
  • Phone: 206-901-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP60098046
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61147514
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: