1962949164 NPI number — STEPHANIE MCWETHY LMFT-S, CMHS, EMMHS

Table of content: STEPHANIE MCWETHY LMFT-S, CMHS, EMMHS (NPI 1962949164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962949164 NPI number — STEPHANIE MCWETHY LMFT-S, CMHS, EMMHS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCWETHY
Provider First Name:
STEPHANIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT-S, CMHS, EMMHS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962949164
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19730 64TH AVE W STE 321
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNNWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98036-5957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-823-1616
Provider Business Mailing Address Fax Number:
360-326-0431

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19730 64TH AVE W STE 321
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNNWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98036-5957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-823-1616
Provider Business Practice Location Address Fax Number:
360-326-0431
Provider Enumeration Date:
01/25/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  LF60077794 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com