Provider Demographics
NPI:1104128479
Name:TOLLISON, SEAN JEREMIAH (PHD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:JEREMIAH
Last Name:TOLLISON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:415 1ST AVE N
Mailing Address - Street 2:STE 200
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-4765
Mailing Address - Country:US
Mailing Address - Phone:206-764-2163
Mailing Address - Fax:206-761-2192
Practice Address - Street 1:1660 S COLUMBIAN WAY
Practice Address - Street 2:MAIL STOP: S-116-DDTP
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1532
Practice Address - Country:US
Practice Address - Phone:206-764-2163
Practice Address - Fax:206-761-2192
Is Sole Proprietor?:No
Enumeration Date:2010-11-18
Last Update Date:2017-02-01
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)