Healthcare Provider Details

I. General information

NPI: 1194234526
Provider Name (Legal Business Name): TIERRA NACHE LOVELACE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 228TH ST SE APT L304
BOTHELL WA
98021-7445
US

IV. Provider business mailing address

1630 228TH ST SE APT L304
BOTHELL WA
98021-7445
US

V. Phone/Fax

Practice location:
  • Phone: 425-341-3846
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC1001430
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: