Provider Demographics
NPI:1023576410
Name:KLEINSCHMIDT, TARA KAY (SC 60929123)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:KAY
Last Name:KLEINSCHMIDT
Suffix:
Gender:F
Credentials:SC 60929123
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 873303
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98687-3303
Mailing Address - Country:US
Mailing Address - Phone:803-201-7958
Mailing Address - Fax:
Practice Address - Street 1:4107 NW FRUIT VALLEY RD STE K
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-1275
Practice Address - Country:US
Practice Address - Phone:803-201-7955
Practice Address - Fax:360-696-4953
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251B00000XAgenciesCase Management