Basic Information
Provider Information
NPI: 1679900575
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CASSNER
FirstName: TIFFANY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.A., NCC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1600 E OLIVE ST
Address2: SOUND MENTAL HEALTH
City: SEATTLE
State: WA
PostalCode: 981222735
CountryCode: US
TelephoneNumber: 2063022200
FaxNumber: 2063022210
Practice Location
Address1: 600 BROADWAY
Address2: MADISON
City: SEATTLE
State: WA
PostalCode: 981225229
CountryCode: US
TelephoneNumber: 2063022600
FaxNumber: 2063022610
Other Information
ProviderEnumerationDate: 10/09/2013
LastUpdateDate: 01/03/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XMC60416440WAY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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