Active NPI
Tewana Y. Martin, CDP
- Addiction (Substance Use Disorder) Counselor
- Auburn, WA
National Provider Identifier
1710157292
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- CP00003063
- Practice address
- 17500 SE 392ND St
Auburn, WA 98092-9705 - Phone
- (253) 939-6648
- NPI assigned
- Mar 11, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CP00003063 | WA | Primary |
Addresses
Primary practice location
17500 SE 392ND St
Auburn, WA 98092-9705
Mailing address
17500 SE 392ND St
Auburn, WA 98092-9705
Phone (253) 939-6648
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CP00003063 | Other | WA | LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CP00003063 | WA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1205193600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1205193600000",
"number": "1710157292",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17500 SE 392ND ST",
"city": "AUBURN",
"state": "WA",
"postal_code": "980929705",
"telephone_number": "253-939-6648"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17500 SE 392ND ST",
"city": "AUBURN",
"state": "WA",
"postal_code": "980929705",
"telephone_number": "253-939-6648"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "TEWANA",
"middle_name": "Y.",
"credential": "CDP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-03-11",
"last_updated": "2008-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WA",
"license": "CP00003063",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "CP00003063",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Auburn, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.