Provider Demographics
NPI:1053677484
Name:BATES, TARA SHIREEN (LMFT)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:SHIREEN
Last Name:BATES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:SCHMUTZLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14831 BURLEY AVE
Mailing Address - Street 2:#488
Mailing Address - City:BURLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14831 BURLEY AVE UNIT 488
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:WA
Practice Address - Zip Code:98322-4021
Practice Address - Country:US
Practice Address - Phone:253-298-9376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2025-06-18
Deactivation Date:2023-01-04
Deactivation Code:
Reactivation Date:2025-06-18
Provider Licenses
StateLicense IDTaxonomies
WALF60442328106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2209360Medicaid