Provider Demographics
NPI:1245814854
Name:PEMBERTON, TARYN BROOKE (LMHCA)
Entity type:Individual
Prefix:
First Name:TARYN
Middle Name:BROOKE
Last Name:PEMBERTON
Suffix:
Gender:F
Credentials:LMHCA
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 462
Mailing Address - Street 2:
Mailing Address - City:VALLEYFORD
Mailing Address - State:WA
Mailing Address - Zip Code:99036-0462
Mailing Address - Country:US
Mailing Address - Phone:509-720-6853
Mailing Address - Fax:
Practice Address - Street 1:5526 E STOUGHTON RD
Practice Address - Street 2:
Practice Address - City:VALLEYFORD
Practice Address - State:WA
Practice Address - Zip Code:99036-9791
Practice Address - Country:US
Practice Address - Phone:509-720-6853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID9415101YM0800X
MT62686101YM0800X
WA61390627101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health