Healthcare Provider Details

I. General information

NPI: 1104950351
Provider Name (Legal Business Name): JAMES TUTTLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 SPEYERS RD
SELAH WA
98942-1050
US

IV. Provider business mailing address

PO BOX 959
YAKIMA WA
98907-0959
US

V. Phone/Fax

Practice location:
  • Phone: 509-225-6311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCQ61663068
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP00000291
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: