Healthcare Provider Details

I. General information

NPI: 1558873729
Provider Name (Legal Business Name): TARA MAY, PHD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 OFFICERS ROW STE D
VANCOUVER WA
98661-3847
US

IV. Provider business mailing address

800 OFFICERS ROW STE D
VANCOUVER WA
98661-3847
US

V. Phone/Fax

Practice location:
  • Phone: 360-904-1008
  • Fax:
Mailing address:
  • Phone: 360-904-1008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberPY60230506
License Number StateWA

VIII. Authorized Official

Name: DR. TARA Z MAY
Title or Position: OWNER
Credential: PHD
Phone: 360-904-1008