Malissa Kautz, CO61248684

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CO61248684 Issued in WA

Practice address

4301 S Pine St Ste 92
Tacoma, WA 98409-7259

Phone

(253) 507-5334

Fax

(253) 330-5182

NPI assigned

Jan 3, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• For the Culture Counseling Services

  • Substance Abuse Rehabilitation Facility
  • Tacoma, WA
  • NPI 1730787763
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1704240000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704240000000",
    "number": "1194595926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11127 10TH AVENUE CT E APT A303",
            "city": "PARKLAND",
            "state": "WA",
            "postal_code": "984457081",
            "telephone_number": "253-592-4509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4301 S PINE ST STE 92",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984097259",
            "telephone_number": "253-507-5334",
            "fax_number": "253-330-5182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAUTZ",
        "first_name": "MALISSA",
        "credential": "CO61248684",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-03",
        "last_updated": "2024-01-03",
        "certification_date": "2024-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CO61248684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sabreena Kaur, PA-C
• Tanisha Kaur, MD
• Mahareta Paubert Kaurin
• Lauren Alexandria Kaus
• Jamie Kautz, LICSW
• Rachelle Kautzman, AU.D.
• Ashley Kay Kauzlaric, ARNP
• Patricia Ann Kaviani, R.T.O.
• Summanther T. Anthony Kaviratne, M.D.
• Erin Aiko Kawasaki, D.O.

• Addiction (Substance Use Disorder) Counselor in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.