Provider Demographics
NPI:1730724071
Name:PROCTOR, TRICIA CHLARSON (PMHNP)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:CHLARSON
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5512 NE 109TH CT STE I
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6175
Mailing Address - Country:US
Mailing Address - Phone:360-200-5273
Mailing Address - Fax:
Practice Address - Street 1:12503 SE MILL PLAIN BLVD STE 123
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-4007
Practice Address - Country:US
Practice Address - Phone:360-215-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP-61012009363LP0808X
WAAP61012009363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health