Provider Demographics
NPI:1306063342
Name:TYKSINSKI, ROSEMARY BANNON (MA, LMHC, PHD, BCC)
Entity type:Individual
Prefix:DR
First Name:ROSEMARY
Middle Name:BANNON
Last Name:TYKSINSKI
Suffix:
Gender:F
Credentials:MA, LMHC, PHD, BCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 112TH AVE NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-2951
Mailing Address - Country:US
Mailing Address - Phone:425-462-5161
Mailing Address - Fax:
Practice Address - Street 1:2200 112TH AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-2951
Practice Address - Country:US
Practice Address - Phone:425-462-5161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALMHC 4359101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC68418OtherNBCC
NC1907OtherBOARD CERTIFIED COACH (BCC); CCE