Provider Demographics
NPI:1417683681
Name:CAIRES, TALIA LEE (CBT)
Entity type:Individual
Prefix:
First Name:TALIA
Middle Name:LEE
Last Name:CAIRES
Suffix:
Gender:F
Credentials:CBT
Other - Prefix:
Other - First Name:TALIA
Other - Middle Name:LEE
Other - Last Name:CLIPPINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:707 W 7TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2833
Mailing Address - Country:US
Mailing Address - Phone:509-850-1080
Mailing Address - Fax:509-461-2532
Practice Address - Street 1:707 W 7TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2833
Practice Address - Country:US
Practice Address - Phone:509-850-1080
Practice Address - Fax:509-461-2532
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
WACB61335714106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2229499Medicaid