Provider Demographics
NPI:1992498174
Name:LUX, TAH-TIANA TAKIRA
Entity type:Individual
Prefix:
First Name:TAH-TIANA
Middle Name:TAKIRA
Last Name:LUX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10423 RAINIER RIDGE BLVD E APT F302
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-8056
Mailing Address - Country:US
Mailing Address - Phone:253-242-0514
Mailing Address - Fax:
Practice Address - Street 1:310 N MERIDIAN STE 209
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-8644
Practice Address - Country:US
Practice Address - Phone:253-339-6094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst