Provider Demographics
NPI:1598297442
Name:PARRISH, STEPHANIE BETH HALVORSEN (MFTA, CDP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:BETH HALVORSEN
Last Name:PARRISH
Suffix:
Gender:F
Credentials:MFTA, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98363-5121
Mailing Address - Country:US
Mailing Address - Phone:360-565-2648
Mailing Address - Fax:360-457-4875
Practice Address - Street 1:1912 W 18TH ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98363-5121
Practice Address - Country:US
Practice Address - Phone:360-565-2648
Practice Address - Fax:360-457-4875
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP 60662076101YA0400X
WAMG 60662044106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)