Healthcare Provider Details

I. General information

NPI: 1598511990
Provider Name (Legal Business Name): BIANCA CELESTE MIFFLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BIANCA FLORES

II. Dates (important events)

Enumeration Date: 04/26/2024
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S PROCTOR ST
TACOMA WA
98405-2047
US

IV. Provider business mailing address

8439 MONTGOMERY ST
JOINT BASE LEWIS MCCHORD WA
98433-1317
US

V. Phone/Fax

Practice location:
  • Phone: 253-396-5800
  • Fax:
Mailing address:
  • Phone: 210-900-6042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: