Healthcare Provider Details

I. General information

NPI: 1255865135
Provider Name (Legal Business Name): BAYSIDE AUTISM THERAPIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2017
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 152ND AVE NE
REDMOND WA
98052-5574
US

IV. Provider business mailing address

1915 140TH AVE NE STE D2146
BELLEVUE WA
98005-2347
US

V. Phone/Fax

Practice location:
  • Phone: 425-429-4793
  • Fax:
Mailing address:
  • Phone: 425-429-4793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number11520651
License Number StateWA

VIII. Authorized Official

Name: TINA R TARVER
Title or Position: OWNER
Credential: BCBA, SLP
Phone: 425-429-4793