Provider Demographics
NPI:1396377586
Name:STADSTAD, EMILY LEE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:LEE
Last Name:STADSTAD
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 N LAKEWOOD DR STE 225
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2473
Mailing Address - Country:US
Mailing Address - Phone:208-984-0989
Mailing Address - Fax:
Practice Address - Street 1:2101 N LAKEWOOD DR STE 225
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2473
Practice Address - Country:US
Practice Address - Phone:208-984-0989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1482124106H00000X
ID7851106H00000X
WA61396310106H00000X
MN3725106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA61396310OtherLICENSED MARRIAGE AND FAMILY THERAPIST
WI1482-124OtherLICENSED MARRIAGE AND FAMILY THERAPIST
ID7851OtherLICENSED MARRIAGE AND FAMILY THERAPIST
MN3725OtherLICENSED MARRIAGE AND FAMILY THERAPIST