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General NPI Number Information
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NPI Number | 1689556086
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Entity Type | Individual
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Provider Name | ALLEN ITUNGU
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Gender | Female
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Dates
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Enumeration Date | 07/24/2025
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 610 YAKIMA AVE
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City | TACOMA
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State | WA
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Zip | 98405-4851
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Country | US
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Telephone | 253-396-5246
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Fax |
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Provider Business Mailing Address
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Address Line | 420 E 83RD ST
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City | TACOMA
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State | WA
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Zip | 98404-1027
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Country | US
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Telephone | 517-771-7174
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | CM61416693
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License Number State | WA
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