Healthcare Provider Details

I. General information

NPI: 1841897634
Provider Name (Legal Business Name): JAMES TANKSLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
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:
Mailing address:
  • Phone: 425-485-6541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61104718
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: