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Individual
TAHTANKA BEAR EAGLE
Active
Individual
TAHTANKA BEAR EAGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LICSW
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
SC60137902
WA
1041C0700X
Clinical Social Worker
Primary
LW60717495
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1044912
—
WA
Enumeration date
09/01/2016
Last updated
01/07/2020
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