Tanya Kehaulani Martin, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LW60247128 Issued in WA

Practice address

600 Broadway St
Longview, WA 98632-3256

Phone

(360) 414-2236

Fax

(360) 414-2788

NPI assigned

Feb 27, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Tanya Kehaulani Koller Former name

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

PeacehealthGroup PAC ID 5890689293, 188 clinicians

Mindful Therapy Group PCGroup PAC ID 4981872561, 654 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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.

• Mindful Therapy Group PC

  • Clinical Social Worker
  • Mountlake Terrace, WA
  • NPI 1316238678
  Medicare reassignment Care Compare group NPD
• Peacehealth

  • Multi-Specialty Clinic/Center
  • Longview, WA
  • NPI 1720056187
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1330300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330300800000",
    "number": "1699049304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3002",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986320302",
            "telephone_number": "360-414-2236",
            "fax_number": "360-414-2788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 BROADWAY ST",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986323256",
            "telephone_number": "360-414-2236",
            "fax_number": "360-414-2788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "TANYA",
        "middle_name": "KEHAULANI",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-27",
        "last_updated": "2012-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WA",
            "license": "CG60156645",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW60247128",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TANYA",
            "last_name": "KOLLER",
            "middle_name": "KEHAULANI",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jacqueline M Marshall, LMP
• Judy Arlene Marsyla, RN
• Donnette Martelle, MA, GMHS
• Brittany Nicole Martin
• Jo Ann Martin
• Lucinda Martinez
• Stephanie Martinez
• Shelley Lynn Maryott-Moore, LICSW, GMHS, CMHS
• Pavel Maslennikov, LMT, PMT
• Christina Mason, PTA

• Clinical Social Worker in Longview, WA
• Providers in Longview, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.