Bear Eagle, Tahtanka

Bear Eagle, Tahtanka is an individual health care provider with primary practice located at 840 E Plum St , Moses Lake WA 98837-1874. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Bear Eagle, Tahtanka can be contacted via phone (509) 765-9239.

Contact Information

Primary practice address
840 E Plum St Moses Lake WA 98837-1874
Phone: (509) 765-9239
Fax: (509) 633-2148
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X SC60137902 Washington
Behavioral Health & Social Service Providers / Clinical 1041C0700X LW60717495 Washington

Profile Details

NPI number 1215483821
LBN Legal business name Bear Eagle, Tahtanka
Credentials MSW, LICSW
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 1st, 2016
Last updated Jan 7th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215483821 NPPES
Washington MEDICAID 1044912

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