MEDICARE: DR. TARA ANNE MURPHY PSY.D.

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	103T00000X	Psychologist
2	103TA0400X	Addiction (Substance Use Disorder) Psychologist	PSY20027	CA
3	103TA0700X	Adult Development & Aging Psychologist	PSY20027	CA
4	103TC0700X	Clinical Psychologist	PSY20027	CA
5	103TC1900X	Counseling Psychologist	PSY20027	CA
6	103TC2200X	Clinical Child & Adolescent Psychologist	PSY20027	CA
7	103TF0000X	Family Psychologist	PSY20027	CA
8	103TM1800X	Intellectual & Developmental Disabilities Psychologist	PSY20027	CA
9	103TP2701X	Group Psychotherapy Psychologist	PSY20027	CA
10	103T00000X	Psychologist	PY60484916	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871677138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TARA ANNE MURPHY PSY.D.

Provider Business Mailing Address
First Line	:	1911 COOKS HILL RD
Second Line	:
City	:	CENTRALIA
State	:	WA
Zip	:	98531-9073
Country	:	US
Telephone Number	:	360-736-6778
Fax Number	:	360-736-6552

Provider Business Practice Location Address
First Line	:	1911 COOKS HILL RD
Second Line	:
City	:	CENTRALIA
State	:	WA
Zip	:	98531
Country	:	US
Telephone Number	:	360-736-6778
Fax Number	:	360-736-6552

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/30/2018

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