MEDICARE: MS. TARA B KELLY LMHCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LH70073156	WA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	101Y00000X	Counselor	CG61380183	WA

General Provider Information

NPI Number	:	1073219515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TARA B KELLY LMHCA

Provider Business Mailing Address
First Line	:	1610 W DEAN AVE
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-1825
Country	:	US
Telephone Number	:	509-795-1955
Fax Number	:

Provider Business Practice Location Address
First Line	:	1610 W DEAN AVE
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-1825
Country	:	US
Telephone Number	:	509-795-1955
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2023
Last Update Date	:	04/13/2026

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