Provider Demographics
NPI:1124874730
Name:VASILEFF, CHRISTIAN TYLER (CBT)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:TYLER
Last Name:VASILEFF
Suffix:
Gender:M
Credentials:CBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11501 STONE AVE N APT C121
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8317
Mailing Address - Country:US
Mailing Address - Phone:360-929-9741
Mailing Address - Fax:
Practice Address - Street 1:14524 MAIN ST NE STE 111
Practice Address - Street 2:
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019-8467
Practice Address - Country:US
Practice Address - Phone:425-505-1320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB61226309106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician