Provider Demographics
NPI:1124205364
Name:DANN, STEPHANIE L (LMFT, ASOTP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:DANN
Suffix:
Gender:F
Credentials:LMFT, ASOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1944 PACIFIC AVE STE 309
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3121
Mailing Address - Country:US
Mailing Address - Phone:253-880-2005
Mailing Address - Fax:253-572-9958
Practice Address - Street 1:1944 PACIFIC AVE STE 309
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3121
Practice Address - Country:US
Practice Address - Phone:253-880-2005
Practice Address - Fax:253-572-9958
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60258086106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist