Healthcare Provider Details

I. General information

NPI: 1134491293
Provider Name (Legal Business Name): CUESTAS -THOMPSON INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2012
Last Update Date: 09/30/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

748 MARKET ST STE 80
TACOMA WA
98402-3737
US

IV. Provider business mailing address

1019 29TH STREET PL NW
PUYALLUP WA
98371-3519
US

V. Phone/Fax

Practice location:
  • Phone: 253-348-2242
  • Fax: 253-697-9938
Mailing address:
  • Phone: 253-348-2242
  • Fax: 253-697-9938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ERIC THOMAS CUESTAS-THOMPSON
Title or Position: THERAPIST
Credential: LICSW, LCSW, LISAC
Phone: 253-348-2242