Healthcare Provider Details

I. General information

NPI: 1275059446
Provider Name (Legal Business Name): TARA ANN MOUNTS MACP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30843 52ND AVE S
AUBURN WA
98001-2727
US

IV. Provider business mailing address

30843 52ND AVE S
AUBURN WA
98001-2727
US

V. Phone/Fax

Practice location:
  • Phone: 253-334-7308
  • Fax:
Mailing address:
  • Phone: 253-334-7308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP61430542
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61199359
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCP5434-R
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10855-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: