Provider Demographics
NPI:1053810663
Name:BOUSHACK, TRICIA (BCBA)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:BOUSHACK
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:
Other - Last Name:TORGESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15022 47TH AVE E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98446-4038
Mailing Address - Country:US
Mailing Address - Phone:253-307-1302
Mailing Address - Fax:
Practice Address - Street 1:744 FAWCETT AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-5505
Practice Address - Country:US
Practice Address - Phone:425-292-9171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-09
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1-18-29262103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst