Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | CG60338605 | WA |
Y | 1041C0700X | Clinical Social Worker | SC60457060 | WA |
NPI | 1003220658 |
---|---|
Provider Name | Tara Symons |
First Address | Kennewick, WA 99336-2950 |
Second Address | Kennewick, WA 99336-2950 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2014 |
Last Update Date | 11/06/2014 |