Healthcare Provider Details

I. General information

NPI: 1649483009
Provider Name (Legal Business Name): DONALD R. TJOSSEM MS, MAC, SAP, CDP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8903 KEY PENINSULA HWY N
LAKEBAY WA
98349-9326
US

IV. Provider business mailing address

8903 KEY PENINSULA HWY N
LAKEBAY WA
98349-9326
US

V. Phone/Fax

Practice location:
  • Phone: 253-884-4860
  • Fax: 253-830-0174
Mailing address:
  • Phone: 253-884-4860
  • Fax: 253-830-0174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberRC00039575
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCPOOOO4019
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: