Provider Demographics
NPI:1417715715
Name:BRANSON, TARA (LMT)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:BRANSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:CRIDDLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:FRONTIER BEHAVIORAL HEALTH
Mailing Address - Street 2:107 SOUTH DIVISION STREET
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202
Mailing Address - Country:US
Mailing Address - Phone:509-838-4651
Mailing Address - Fax:
Practice Address - Street 1:FRONTIER BEHAVIORAL HEALTH
Practice Address - Street 2:107 S DIVISION STREET
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-5087
Practice Address - Country:US
Practice Address - Phone:509-838-4651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No175T00000XOther Service ProvidersPeer Specialist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist