Provider Demographics
NPI:1275696536
Name:PLATZ, TARA JEANE (MED)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:JEANE
Last Name:PLATZ
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 CORNWALL AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5023
Mailing Address - Country:US
Mailing Address - Phone:360-676-7342
Mailing Address - Fax:
Practice Address - Street 1:1229 CORNWALL AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5023
Practice Address - Country:US
Practice Address - Phone:360-676-7342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00053776101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health