Provider Demographics
NPI:1063496511
Name:STANFILL, BRYAN E (MA)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:E
Last Name:STANFILL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 S ARTHUR ST
Mailing Address - Street 2:SUITE 510
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2260
Mailing Address - Country:US
Mailing Address - Phone:509-326-6996
Mailing Address - Fax:509-328-9919
Practice Address - Street 1:140 S ARTHUR ST
Practice Address - Street 2:SUITE 510
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2260
Practice Address - Country:US
Practice Address - Phone:509-326-6996
Practice Address - Fax:509-328-9919
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00008767101YM0800X, 101YP2500X
WALH0008767101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1114913Medicaid