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NPI Code Detail

MEDICARE: TIA BABY SOPHAL

MEDICARE: TIA BABY SOPHAL
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
1101Y00000XCounselorWA

General Provider Information

NPI Number : 1922950591
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIA BABY SOPHAL
Provider Business Mailing Address
First Line : 8911 GRAVELLY LAKE DR SW APT 149
Second Line :
City : LAKEWOOD
State : WA
Zip : 98499-3217
Country : US
Telephone Number : 253-330-6085
Fax Number : 253-330-6085
Provider Business Practice Location Address
First Line : 2200 RAINIER AVE S
Second Line :
City : SEATTLE
State : WA
Zip : 98144-4642
Country : US
Telephone Number : 206-417-9904
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2026
Last Update Date : 02/13/2026

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Directions to “ TIA BABY SOPHAL ” Practice Location

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