Provider Demographics
NPI:1003220658
Name:SYMONS, TARA (LICSWA)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:SYMONS
Suffix:
Gender:F
Credentials:LICSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N MORAIN ST
Mailing Address - Street 2:BLDG 1 STE 1250
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2950
Mailing Address - Country:US
Mailing Address - Phone:509-783-0500
Mailing Address - Fax:
Practice Address - Street 1:500 N MORAIN ST
Practice Address - Street 2:BLDG 1 STE 1250
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2950
Practice Address - Country:US
Practice Address - Phone:509-783-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60338605101YM0800X
WASC604570601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health