Tarae Blackmon, SUDP
Counselor, Addiction (Substance Use Disorder) in Tacoma, WA. Individual provider (NPI-1).
NPI number1760195481
StatusActive
Last updated in NPPESDec 27, 2022
Details
- NPI
- 1760195481
- Entity type
- Individual (NPI-1)
- Name
- Tarae Blackmon
- Credential
- SUDP
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Dec 27, 2022
- Certification date
- Dec 27, 2022
- Last updated
- Dec 27, 2022
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YA0400X | Counselor, Addiction (Substance Use Disorder) | – | – | Yes |
Practice location
721 Fawcett Ave Ste 204Tacoma, WA 98402-5502
Phone 253-389-3383
Mailing address
6536 A StTacoma, WA 98408-7308
Phone 253-754-7389
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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