Provider Demographics
NPI:1073766978
Name:SACKS, STEPHANIE LYNN (MA, LMHC)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:LYNN
Last Name:SACKS
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 N MILDRED ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-1725
Mailing Address - Country:US
Mailing Address - Phone:253-597-6424
Mailing Address - Fax:253-597-6443
Practice Address - Street 1:633 N MILDRED ST
Practice Address - Street 2:SUITE J
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-1725
Practice Address - Country:US
Practice Address - Phone:253-597-6424
Practice Address - Fax:253-597-6443
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006008101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health