Provider Demographics
NPI:1073024394
Name:TAYLOR, TAMARA LEIGH (PHD)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:LEIGH
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5719 84TH ST E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-6364
Mailing Address - Country:US
Mailing Address - Phone:253-888-6463
Mailing Address - Fax:
Practice Address - Street 1:6512 20TH STREET CT W STE B
Practice Address - Street 2:
Practice Address - City:FIRCREST
Practice Address - State:WA
Practice Address - Zip Code:98466-6212
Practice Address - Country:US
Practice Address - Phone:253-888-6463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60169025101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health