Individual
MR. TYLER SHANE DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CP61119971
Contact information
Practice address
111 SOUTH 2ND AVE, YAKIMA, WA 98902
(509) 575-2885
Mailing address
401 S 12TH AVE, YAKIMA, WA 98902-3114
(509) 864-1282
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP61119971
WA
Other
Enumeration date
08/01/2018
Last updated
03/16/2026
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