Provider Demographics
NPI:1396001749
Name:SPOKANE THERAPIST LLC
Entity Type:Organization
Organization Name:SPOKANE THERAPIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:STOOPS
Authorized Official - Suffix:
Authorized Official - Credentials:MED, MHCA, NCC
Authorized Official - Phone:5092-029-9486
Mailing Address - Street 1:1212 N WASHINGTON ST
Mailing Address - Street 2:206
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2403
Mailing Address - Country:US
Mailing Address - Phone:509-209-9486
Mailing Address - Fax:509-232-0883
Practice Address - Street 1:1212 N WASHINGTON ST
Practice Address - Street 2:206
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2403
Practice Address - Country:US
Practice Address - Phone:509-209-9486
Practice Address - Fax:509-232-0883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60115047101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty