Healthcare Provider Details

I. General information

NPI: 1407274731
Provider Name (Legal Business Name): TAMARA JEAN WRIGHT MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 06/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E CLAY AVE # 201
CHEWELAH WA
99109-8936
US

IV. Provider business mailing address

301 E CLAY AVE # 201 PO BOX 905
CHEWELAH WA
99109-8936
US

V. Phone/Fax

Practice location:
  • Phone: 509-935-4808
  • Fax: 509-935-4897
Mailing address:
  • Phone: 509-935-4808
  • Fax: 509-935-4897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCG60572595
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6802088067
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: