Provider Demographics
NPI:1477989994
Name:CALDWELL, TARA L
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:L
Last Name:CALDWELL
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 1:3904 SPRINGLAND LN
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-6866
Mailing Address - Country:US
Mailing Address - Phone:360-778-2312
Mailing Address - Fax:
Practice Address - Street 1:3904 SPRINGLAND LN
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6866
Practice Address - Country:US
Practice Address - Phone:360-778-2312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health