Individual
ALEJANDRO ANTONIO TAVIRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CG 60475423
Contact information
Practice address
7610 40TH ST W STE 300, UNIVERSITY PLACE, WA 98466-3834
(253) 830-6242
Mailing address
8222 E B ST, TACOMA, WA 98404-1031
(253) 720-5739
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
CG60475423
WA
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CG60475423
—
WA
Enumeration date
12/21/2018
Last updated
09/05/2019
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