MEDICARE: TABATHA LYNN CARLSON

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	101YP2500X	Professional Counselor	CAAR.CG.70140811	WA

General Provider Information

NPI Number	:	1740111467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TABATHA LYNN CARLSON

Provider Business Mailing Address
First Line	:	2018 W 19TH AVE
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99337-3517
Country	:	US
Telephone Number	:	509-905-1904
Fax Number	:

Provider Business Practice Location Address
First Line	:	2018 W 19TH AVE
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99337-3517
Country	:	US
Telephone Number	:	509-905-1904
Fax Number	:

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

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	05/29/2026

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