Healthcare Provider Details

I. General information

NPI: 1689556086
Provider Name (Legal Business Name): ALLEN ITUNGU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 YAKIMA AVE
TACOMA WA
98405-4851
US

IV. Provider business mailing address

420 E 83RD ST
TACOMA WA
98404-1027
US

V. Phone/Fax

Practice location:
  • Phone: 253-396-5246
  • Fax:
Mailing address:
  • Phone: 517-771-7174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberCM61416693
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: