Provider Demographics
NPI:1003214016
Name:BROADGATE, STEPHANIE (LMFT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BROADGATE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 718
Mailing Address - Street 2:
Mailing Address - City:METHOW
Mailing Address - State:WA
Mailing Address - Zip Code:98834-0718
Mailing Address - Country:US
Mailing Address - Phone:206-456-6229
Mailing Address - Fax:
Practice Address - Street 1:24 MAIN STREET
Practice Address - Street 2:
Practice Address - City:METHOW
Practice Address - State:WA
Practice Address - Zip Code:98834
Practice Address - Country:US
Practice Address - Phone:206-456-6229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-08
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF61399760106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist