Healthcare Provider Details

I. General information

NPI: 1306349477
Provider Name (Legal Business Name): TATIANA ESCALERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 03/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 8TH ST
HOQUIAM WA
98550-3522
US

IV. Provider business mailing address

921 14TH AVE
LONGVIEW WA
98632-2316
US

V. Phone/Fax

Practice location:
  • Phone: 360-532-4357
  • Fax: 360-538-0124
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number60815726
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: