Provider Demographics
NPI:1114348190
Name:STELL, JACK POWELL (LMFT, CDP)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:POWELL
Last Name:STELL
Suffix:
Gender:M
Credentials:LMFT, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11504 E FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206
Mailing Address - Country:US
Mailing Address - Phone:509-221-0415
Mailing Address - Fax:509-210-6857
Practice Address - Street 1:1014 N PINES RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-6707
Practice Address - Country:US
Practice Address - Phone:509-221-0425
Practice Address - Fax:509-210-6857
Is Sole Proprietor?:No
Enumeration Date:2013-12-18
Last Update Date:2015-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60288035101YA0400X
WALF60178610106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)