Healthcare Provider Details

I. General information

NPI: 1598387631
Provider Name (Legal Business Name): TAMARA LEE ALLISON LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 NE 129TH ST STE 101
VANCOUVER WA
98686-3270
US

IV. Provider business mailing address

1441 HAZEL DELL RD
CASTLE ROCK WA
98611-9438
US

V. Phone/Fax

Practice location:
  • Phone: 360-574-9303
  • Fax:
Mailing address:
  • Phone: 360-270-4156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60735759
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: