Taryn Brooke Pemberton, LMHCA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

61390627 Issued in WA

Practice address

5526 E Stoughton Rd
Valleyford, WA 99036-9791

Phone

(509) 720-6853

NPI assigned

May 10, 2021

Last updated

Apr 23, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 14, 2024 through Jan 14, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1620604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713830400000",
    "number": "1245814854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 462",
            "city": "VALLEYFORD",
            "state": "WA",
            "postal_code": "990360462",
            "telephone_number": "509-720-6853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5526 E STOUGHTON RD",
            "city": "VALLEYFORD",
            "state": "WA",
            "postal_code": "990369791",
            "telephone_number": "509-720-6853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEMBERTON",
        "first_name": "TARYN",
        "middle_name": "BROOKE",
        "credential": "LMHCA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-10",
        "last_updated": "2024-04-23",
        "certification_date": "2024-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "ID",
            "license": "9415",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MT",
            "license": "62686",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "61390627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gilbert Dennis Clifton, PHARMD
• Mary Christine D'Auria, M. T.
• Jason Louis Iltz, B.PHARM., PHARM.D.
• Mary D'Auria (Ke Haku Kaiyah)
• Kristina Luella Rice Erso, PHD
• Leslie Spring, LMP
• Wind and Water Psychiatry LLC

• Mental Health Counselor in Valleyford, WA
• Providers in Valleyford, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.