Tahtanka Bear Eagle, MSW, LICSW is a
Social Worker - Clinical based in Moses Lake, Washington. Tahtanka Bear Eagle is licensed to practice in Washington (license number LW60717495) and his current practice location is
840 E Plum St, Moses Lake, Washington. He can be reached at his office (for appointments etc.) via phone at
(509) 765-9239.
NPI number for Tahtanka Bear Eagle is 1215483821 and his current mailing address is Po Box 1057, Moses Lake, Washington. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1215483821.
Healthcare Provider's Profile
| Full Name | Tahtanka Bear Eagle |
|---|
| Gender | Male |
|---|
| Speciality | Social Worker - Clinical |
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| Location | 840 E Plum St, Moses Lake, Washington |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1215483821
- Provider Enumeration Date: 09/01/2016
- Last Update Date: 01/07/2020
Medical Identifiers
Medical identifiers for Tahtanka Bear Eagle such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1215483821 | NPI | - | NPPES |
| 1044912 | Medicaid | WA | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YM0800X | Counselor - Mental Health | SC60137902 (Washington) | Secondary |
| 1041C0700X | Social Worker - Clinical | LW60717495 (Washington) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Tahtanka Bear Eagle is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Tahtanka Bear Eagle, MSW, LICSW
Po Box 1057,
Moses Lake, WA 98837-0160
Ph: (509) 765-9239 | Tahtanka Bear Eagle, MSW, LICSW
840 E Plum St,
Moses Lake, WA 98837-1874
Ph: (509) 765-9239 |
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