Waterbury Wallace, Tessa Tara
Waterbury Wallace, Tessa Tara is an individual health care provider with primary practice located at 65371 Hwy 14 , White Salmon WA 98672-9867. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Waterbury Wallace, Tessa Tara can be contacted via phone (509) 493-2133.Contact Information
Primary practice address
65371 Hwy 14
White Salmon WA 98672-9867
Phone: (509) 493-2133
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 858LCSW | Montana |
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | L4499 | Oregon |
Profile Details
| NPI number | 1578705950 |
|---|---|
| LBN Legal business name | Waterbury Wallace, Tessa Tara |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 31st, 2009 |
| Last updated | Nov 19th, 2018 - about 6 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1578705950 | NPPES |
| Oregon | MEDICAID | 218112 |
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