Provider Demographics
NPI:1073040762
Name:HUGGINS, TARA AMBER NICOLE
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:AMBER NICOLE
Last Name:HUGGINS
Suffix:
Gender:F
Credentials:
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 277
Mailing Address - Street 2:
Mailing Address - City:LA PUSH
Mailing Address - State:WA
Mailing Address - Zip Code:98350
Mailing Address - Country:US
Mailing Address - Phone:360-374-3138
Mailing Address - Fax:360-374-4015
Practice Address - Street 1:191 OCEAN DRIVE
Practice Address - Street 2:
Practice Address - City:LA PUSH
Practice Address - State:WA
Practice Address - Zip Code:98350
Practice Address - Country:US
Practice Address - Phone:360-374-3138
Practice Address - Fax:360-374-4015
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL60571614101Y00000X
WAMC60541653101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor