Healthcare Provider Details

I. General information

NPI: 1326829433
Provider Name (Legal Business Name): CRITICAL TIME INTERVENTION PIERCE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2023
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 PACIFIC AVE STE 600
TACOMA WA
98402-4384
US

IV. Provider business mailing address

17110 31ST ST NW
LAKEBAY WA
98349-8536
US

V. Phone/Fax

Practice location:
  • Phone: 253-348-3742
  • Fax:
Mailing address:
  • Phone: 253-348-3742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: LISA LYENTTE KLEINER
Title or Position: DIRECTOR OF CLINICAL SERVICES
Credential: BA
Phone: 253-348-3742