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General NPI Number Information
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NPI Number | 1932286101
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Entity Type | Organization
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Legal Business Name | CASCADIA ADDICTION-BOUNTIFUL LIFE TREATMENT CENTER PLLC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 2817 WHEATON WAY STE 205
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City | BREMERTON
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State | WA
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Zip | 98310-3440
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Country | US
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Telephone | 360-373-0155
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Fax | 360-373-0258
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Provider Business Mailing Address
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Address Line | 2817 WHEATON WAY STE 205
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City | BREMERTON
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State | WA
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Zip | 98310-3440
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Country | US
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Telephone | 360-373-0155
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Fax | 360-373-0258
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. STEVEN PAUL TIKUNOFF JR.
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Credential | SUDP
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Telephone | 360-373-0155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CP00002242
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | CP00002242
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License Number State | WA
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