Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | MC60169245 | WA |
NPI | 1003114307 |
---|---|
Provider Name | Lisa Anne Taft |
First Address | Bellingham, WA 98226-9278 |
Second Address | Bellingham, WA 98226-9278 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2011 |
Last Update Date | 10/03/2011 |