Provider Demographics
NPI:1538620646
Name:TALLMAN, MICHAEL TYLER (MSW, MHP, LSWAIC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TYLER
Last Name:TALLMAN
Suffix:
Gender:M
Credentials:MSW, MHP, LSWAIC
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:TYLER
Other - Last Name:TALLMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3320 173RD PL NE # 95
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-8712
Mailing Address - Country:US
Mailing Address - Phone:425-349-8700
Mailing Address - Fax:
Practice Address - Street 1:3320 173RD PL NE # 95
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8712
Practice Address - Country:US
Practice Address - Phone:425-349-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60954904101Y00000X, 101YM0800X
390200000X
WASC61417058104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program