Provider Demographics
NPI:1285302083
Name:GITTENS, TAMERA (LMHC)
Entity type:Individual
Prefix:MS
First Name:TAMERA
Middle Name:
Last Name:GITTENS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LENORA STREET
Mailing Address - Street 2:PMB 1348
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121
Mailing Address - Country:US
Mailing Address - Phone:347-601-9921
Mailing Address - Fax:
Practice Address - Street 1:1430 2ND AVE APT 902
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-3366
Practice Address - Country:US
Practice Address - Phone:347-601-9921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-06
Last Update Date:2022-10-24
Deactivation Date:2022-10-13
Deactivation Code:
Reactivation Date:2022-10-19
Provider Licenses
StateLicense IDTaxonomies
WA61214113101YM0800X
WA61365848101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty