Provider Demographics
NPI:1699241208
Name:DR. DESEY TZIORTZIS, LLC
Entity type:Organization
Organization Name:DR. DESEY TZIORTZIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DESEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TZIORTZIS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:323-459-8050
Mailing Address - Street 1:5306 BALLARD AVE NW STE 321
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-4366
Mailing Address - Country:US
Mailing Address - Phone:323-459-8050
Mailing Address - Fax:
Practice Address - Street 1:5306 BALLARD AVE NW STE 321
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4366
Practice Address - Country:US
Practice Address - Phone:323-459-8050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty