Provider Demographics
NPI:1215325709
Name:MARRAZZO, TANYA KAI (MS CDP MHP LMHC)
Entity type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:KAI
Last Name:MARRAZZO
Suffix:
Gender:F
Credentials:MS CDP MHP LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 N PINES RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4986
Mailing Address - Country:US
Mailing Address - Phone:509-389-8559
Mailing Address - Fax:
Practice Address - Street 1:1005 N PINES RD
Practice Address - Street 2:SUITE 120
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4986
Practice Address - Country:US
Practice Address - Phone:509-389-8550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60280436101YA0400X
WALH 60510123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2044924Medicaid