=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699208298
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YOLONDA MASSEY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2017
-----------------------------------------------------
Last Update Date | 02/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5324 84TH ST E
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98446-5627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-446-6630
-----------------------------------------------------
Fax | 253-322-7694
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1529 202ND STREET CT E
-----------------------------------------------------
City | SPANAWAY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98387-1825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-262-9100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | LF61050559
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------