MEDICARE: TONYA GESCHKE-CARLSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LF60218377	WA

General Provider Information

NPI Number	:	1609295294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONYA GESCHKE-CARLSON

Provider Business Mailing Address
First Line	:	2814 S GRAND BLVD
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99203-2528
Country	:	US
Telephone Number	:	509-279-4864
Fax Number	:

Provider Business Practice Location Address
First Line	:	2814 S GRAND BLVD
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99203-2528
Country	:	US
Telephone Number	:	509-279-4864
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2014
Last Update Date	:	01/10/2020

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