Provider Demographics
NPI:1760532261
Name:STAFFORD-LEWIS, MARCY ANN (MA LMHC)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:ANN
Last Name:STAFFORD-LEWIS
Suffix:
Gender:F
Credentials:MA LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1611
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-0197
Mailing Address - Country:US
Mailing Address - Phone:360-697-1141
Mailing Address - Fax:360-697-2395
Practice Address - Street 1:20174 FRONT ST
Practice Address - Street 2:
Practice Address - City:POULSBORO
Practice Address - State:WA
Practice Address - Zip Code:98370
Practice Address - Country:US
Practice Address - Phone:360-697-1141
Practice Address - Fax:360-697-2395
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA020703CH00005939101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health