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NPI Code Detail

MEDICARE: MEGAN NICOLE TACKES

MEDICARE: MEGAN NICOLE TACKES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1568921534
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEGAN NICOLE TACKES
Provider Business Mailing Address
First Line : 1508 W 6TH AVE
Second Line :
City : SPOKANE
State : WA
Zip : 99204-3409
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1508 W 6TH AVE
Second Line :
City : SPOKANE
State : WA
Zip : 99204-3409
Country : US
Telephone Number : 509-624-5228
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2019
Last Update Date : 03/18/2019

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Directions to “ MEGAN NICOLE TACKES ” Practice Location

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