Provider Demographics
NPI:1043929789
Name:DEARBORN, STEPHEN RAY (MFT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:RAY
Last Name:DEARBORN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 RASMUSSEN LN
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-2852
Mailing Address - Country:US
Mailing Address - Phone:720-236-8491
Mailing Address - Fax:
Practice Address - Street 1:717 RASMUSSEN LN
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-2852
Practice Address - Country:US
Practice Address - Phone:720-236-8491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG61110792101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty