Provider Demographics
NPI:1346546918
Name:CISSELL, TAMARA T (MSW, CDP)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:T
Last Name:CISSELL
Suffix:
Gender:F
Credentials:MSW, CDP
Other - Prefix:MS
Other - First Name:TAMARA
Other - Middle Name:T
Other - Last Name:WEHRER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, CDP
Mailing Address - Street 1:PO BOX 1492
Mailing Address - Street 2:
Mailing Address - City:STEVENSON
Mailing Address - State:WA
Mailing Address - Zip Code:98648-1492
Mailing Address - Country:US
Mailing Address - Phone:509-427-3850
Mailing Address - Fax:509-427-0188
Practice Address - Street 1:710 SW ROCK CREEK DR
Practice Address - Street 2:
Practice Address - City:STEVENSON
Practice Address - State:WA
Practice Address - Zip Code:98648-4418
Practice Address - Country:US
Practice Address - Phone:509-427-3850
Practice Address - Fax:509-427-0188
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60199613101YA0400X
WALW602809651041C0700X
WASW60146458104100000X
ORA2522104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical