Provider Demographics
NPI:1346523677
Name:FROELICH, STACEY RAE (MA LMHC NCC)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:RAE
Last Name:FROELICH
Suffix:
Gender:F
Credentials:MA LMHC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 S 2ND ST STE 128
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-3814
Mailing Address - Country:US
Mailing Address - Phone:360-966-6161
Mailing Address - Fax:360-462-1072
Practice Address - Street 1:317 S 2ND ST STE 128
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273
Practice Address - Country:US
Practice Address - Phone:360-966-6161
Practice Address - Fax:360-246-1072
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60476190101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health