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General NPI Number Information
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NPI Number | 1376853762
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Entity Type | Individual
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Provider Name | TARA LYNN CLARK LMHC, LSWAIC, MSW
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Gender | Female
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Dates
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Enumeration Date | 10/19/2010
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Last Update Date | 07/31/2020
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Provider Practice Location Address
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Address Line | 3539 DIANNA WAY
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City | WENATCHEE
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State | WA
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Zip | 98801-9142
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Country | US
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Telephone | 509-334-7123
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Fax |
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Provider Business Mailing Address
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Address Line | 1250 N WENATCHEE AVE STE H #330
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City | WENATCHEE
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State | WA
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Zip | 98801-1599
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Country | US
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Telephone | 509-334-7123
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SC60863365
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH61072662
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License Number State | WA
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