Provider Demographics
NPI:1811375330
Name:WALLINGER, STEPHEN (MED, LMHCA)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:WALLINGER
Suffix:
Gender:M
Credentials:MED, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 NE 104TH ST APT A
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-7426
Mailing Address - Country:US
Mailing Address - Phone:425-213-8864
Mailing Address - Fax:
Practice Address - Street 1:320 NE 97TH ST STE A
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2042
Practice Address - Country:US
Practice Address - Phone:206-453-5707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-16
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61429647101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health