Healthcare Provider Details

I. General information

NPI: 1013474030
Provider Name (Legal Business Name): TYRONE ALEXANDER CAWSTON AAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 STATE AVE NE
OLYMPIA WA
98506-3984
US

IV. Provider business mailing address

711 STATE AVE NE
OLYMPIA WA
98506-3984
US

V. Phone/Fax

Practice location:
  • Phone: 360-943-0780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG60942398
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: