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General NPI Number Information
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NPI Number | 1912691080
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Entity Type | Organization
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Legal Business Name | TISE CONSULTING AND THERAPY
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Dates
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Enumeration Date | 06/02/2023
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Last Update Date | 09/26/2023
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Provider Practice Location Address
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Address Line | 1527 14TH AVE S APT 202
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City | SEATTLE
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State | WA
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Zip | 98144-7406
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Country | US
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Telephone | 626-884-4578
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 28094
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City | SEATTLE
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State | WA
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Zip | 98118-1094
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOLE OWNER
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Name | JAYDEN AUBRYN
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Credential | LICSW
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Telephone | 626-884-4578
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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