Healthcare Provider Details

I. General information

NPI: 1831918655
Provider Name (Legal Business Name): KIERRA TANEISHA MIDDLETON MFTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16618 E BROADWAY AVE
SPOKANE VALLEY WA
99037-8553
US

IV. Provider business mailing address

100 N HOWARD ST STE R
SPOKANE WA
99201-0508
US

V. Phone/Fax

Practice location:
  • Phone: 509-315-3231
  • Fax:
Mailing address:
  • Phone: 509-351-3231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFTA.MG.70085567
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: