Provider Demographics
NPI:1073161766
Name:STACY BEATTY LMHC LLC
Entity Type:Organization
Organization Name:STACY BEATTY LMHC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEATTY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:253-409-1919
Mailing Address - Street 1:18209 SR 410 E STE 304
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-5146
Mailing Address - Country:US
Mailing Address - Phone:253-409-1919
Mailing Address - Fax:253-299-8445
Practice Address - Street 1:18209 SR 410 E STE 304
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-5146
Practice Address - Country:US
Practice Address - Phone:253-409-1919
Practice Address - Fax:253-299-8445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty