Individual
TENNILLE ANNA LIGHTFOOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CP00005071
Contact information
Practice address
3400 W GARLAND AVE, SPOKANE, WA 99205-2119
(509) 325-2355
(509) 326-3370
Mailing address
14025 N KOTH RD, NEWMAN LAKE, WA 99025-9484
(509) 954-7480
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP00005071
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CP00005071
—
WA
Enumeration date
12/21/2018
Last updated
12/21/2018
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