Provider Demographics
NPI:1497126320
Name:STAUBER, HEIDI (LMFTA)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:
Last Name:STAUBER
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N 130TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-7907
Mailing Address - Country:US
Mailing Address - Phone:206-250-3396
Mailing Address - Fax:
Practice Address - Street 1:3400 HARBOR AVE SW
Practice Address - Street 2:SUITE #437
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-2394
Practice Address - Country:US
Practice Address - Phone:206-250-3396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60524045106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist