Provider Demographics
NPI:1205060134
Name:JAMES, TARA-WILLOW FERREN (MD)
Entity type:Individual
Prefix:DR
First Name:TARA-WILLOW
Middle Name:FERREN
Last Name:JAMES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TARA-WILLOW
Other - Middle Name:
Other - Last Name:FERREN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3754 W INDIAN TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-4700
Mailing Address - Country:US
Mailing Address - Phone:509-559-3100
Mailing Address - Fax:509-588-7437
Practice Address - Street 1:3754 W INDIAN TRAIL RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-4700
Practice Address - Country:US
Practice Address - Phone:509-559-3100
Practice Address - Fax:509-588-7437
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD605451752084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1205060134Medicaid