Healthcare Provider Details

I. General information

NPI: 1053276212
Provider Name (Legal Business Name): TIFFANY CAPRI CHILDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11900 BEACON AVE S
SEATTLE WA
98178-2811
US

IV. Provider business mailing address

14598 WESTMINSTER WAY N UNIT 110
SHORELINE WA
98133-6457
US

V. Phone/Fax

Practice location:
  • Phone: 206-772-6900
  • Fax: 206-772-6900
Mailing address:
  • Phone: 425-219-0592
  • Fax: 425-219-0592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO61488946
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: