Healthcare Provider Details

I. General information

NPI: 1265907646
Provider Name (Legal Business Name): TARA L BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3727 E ROCKY RIDGE RD
CHATTAROY WA
99003-9650
US

IV. Provider business mailing address

3727 E ROCKY RIDGE RD
CHATTAROY WA
99003-9650
US

V. Phone/Fax

Practice location:
  • Phone: 509-868-1861
  • Fax:
Mailing address:
  • Phone: 509-868-1861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH1088624
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP60672795
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC60867976
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: