Provider Demographics
NPI:1326633983
Name:YANAGAWA, STACY (MASTERS OF EDUCATION)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:YANAGAWA
Suffix:
Gender:F
Credentials:MASTERS OF EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 UNIVERSITY LAKE DR STE 205
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4658
Mailing Address - Country:US
Mailing Address - Phone:907-729-2492
Mailing Address - Fax:
Practice Address - Street 1:3801 UNIVERSITY LAKE DRIVE
Practice Address - Street 2:SUITE 205
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-729-2492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health