Provider Demographics
NPI:1043084205
Name:SEABOURN, TIANNA KAY (CPC)
Entity type:Individual
Prefix:
First Name:TIANNA
Middle Name:KAY
Last Name:SEABOURN
Suffix:
Gender:F
Credentials:CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2344 CARPENTER RD SE APT F
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-4091
Mailing Address - Country:US
Mailing Address - Phone:360-480-1229
Mailing Address - Fax:
Practice Address - Street 1:2344 CARPENTER RD SE APT F
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-4091
Practice Address - Country:US
Practice Address - Phone:360-480-1229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2025-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 172V00000X
WA171M00000X
WACG61618464101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker