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General NPI Number Information
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NPI Number | 1912894205
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Entity Type | Organization
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Legal Business Name | COUNSELOR COACH THERAPIST LLC
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Dates
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Enumeration Date | 06/19/2025
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 100 N HOWARD ST STE R
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City | SPOKANE
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State | WA
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Zip | 99201-0508
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Country | US
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Telephone | 564-224-3445
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Fax |
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Provider Business Mailing Address
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Address Line | 100 N HOWARD ST STE R
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City | SPOKANE
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State | WA
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Zip | 99201-0508
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Country | US
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Telephone | 564-224-3445
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Fax |
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Authorized Official
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Title or Position | COUNSELOR COACH THERAPIST
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Name | TARA GAYLE MANN
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Credential | LMFT
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Telephone | 564-224-3445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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