MEDICARE: TARA GAYLE MANN

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	106H00000X	Marriage & Family Therapist	IMF52881	CA
2	106H00000X	Marriage & Family Therapist	IMF74530	CA
3	106H00000X	Marriage & Family Therapist	LF61366693	WA

General Provider Information

NPI Number	:	1194858043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA GAYLE MANN

Provider Business Mailing Address
First Line	:	100 N HOWARD ST STE R
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-0508
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 N HOWARD ST STE R
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-0508
Country	:	US
Telephone Number	:	564-224-3445
Fax Number	:

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	06/30/2025

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Directions to “ TARA GAYLE MANN ” Practice Location

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