Provider Demographics
NPI:1790499739
Name:MINCHOW, TAMARA (MSW, LICSWA)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:MINCHOW
Suffix:
Gender:F
Credentials:MSW, LICSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4407 N DIVISION ST STE 205
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1660
Mailing Address - Country:US
Mailing Address - Phone:425-445-2513
Mailing Address - Fax:
Practice Address - Street 1:4407 N DIVISION ST STE 205
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1660
Practice Address - Country:US
Practice Address - Phone:509-919-2156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC613422671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical