Healthcare Provider Details

I. General information

NPI: 1316544174
Provider Name (Legal Business Name): STEVEN PAUL TIKUNOFF JR. CO61095300
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: STEVEN P TIKUNOFF JR. CP61442118

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 WHEATON WAY STE 205
BREMERTON WA
98310-3440
US

IV. Provider business mailing address

2817 WHEATON WAY STE 205
BREMERTON WA
98310-3440
US

V. Phone/Fax

Practice location:
  • Phone: 360-373-0155
  • Fax:
Mailing address:
  • Phone: 360-373-0155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP61442118
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: