Provider Demographics
NPI:1417163437
Name:TAYLOR, STACEY MARIE
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:MARIE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18422 103RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3410
Mailing Address - Country:US
Mailing Address - Phone:254-940-8014
Mailing Address - Fax:866-764-2841
Practice Address - Street 1:18422 103RD AVE NE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3410
Practice Address - Country:US
Practice Address - Phone:425-494-0801
Practice Address - Fax:866-764-2841
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WA61376037103K00000X
WA106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst