Individual ProviderTara Lynn KennedyCounselorBehavioral Health & Social Service ProvidersPractice Address1601 E 4th Plain Blvd, Bldg 17 Ste B222, Vancouver, WA 98661-3713(360) 397-8484PECOS EnrollmentBased on the most recent information from CMS, provider Tara Lynn Kennedy does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 10:04 AM.Profile DetailsProvider ID1154871853Provider TypeIndividualFull NameKennedy, Tara LynnTitleMs.CredentialMAGenderFemaleSole ProprietorNoEnumeration Date10/6/2016Last Updated10/6/2016Contact InformationPractice LocationPractice Address1601 E 4th Plain Blvd, Bldg 17 Ste B222, Vancouver, WA 98661-3713Phone(360) 397-8484Fax(360) 397-8494Mailing LocationMailing AddressPO Box 1845, Vancouver, WA 98668-1845Phone(360) 397-8484Fax(360) 397-8494Provider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseCG60703533Washington