Healthcare Provider Details

I. General information

NPI: 1578737078
Provider Name (Legal Business Name): TINA LYN BARGER ANDERSON MSW/SWAICL/MHP/CDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 E 8TH AVE
SPOKANE VALLEY WA
99212-0220
US

IV. Provider business mailing address

PO BOX 540
WELLPINIT WA
99040-0540
US

V. Phone/Fax

Practice location:
  • Phone: 509-533-6910
  • Fax: 509-795-8309
Mailing address:
  • Phone: 509-258-7502
  • Fax: 509-258-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP 60335013
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number60690797
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: