Basic Information
| Provider Information | |||||||||
| NPI: | 1871103713 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CROUCH | ||||||||
| FirstName: | TARA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 S COLUMBIAN WAY | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981081565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067621010 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1660 S COLUMBIAN WAY | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981081532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067165947 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2020 | ||||||||
| LastUpdateDate: | 03/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PY61003629 | WA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.