Healthcare Provider Details

I. General information

NPI: 1336926468
Provider Name (Legal Business Name): TASNEEM DADABHOY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 09/12/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19201 120TH AVE NE STE 108
BOTHELL WA
98011-9523
US

IV. Provider business mailing address

19201 120TH AVE NE STE 108
BOTHELL WA
98011-9523
US

V. Phone/Fax

Practice location:
  • Phone: 425-485-6541
  • Fax: 425-485-4154
Mailing address:
  • Phone: 425-485-6541
  • Fax: 425-485-4154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCG61478861
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSA61464849
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: