Provider Demographics
NPI:1881180610
Name:MRAKOVICH, STEPHANIE JORDAN (LMHCA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JORDAN
Last Name:MRAKOVICH
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2484 DEXTER AVE N APT 2
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-2245
Mailing Address - Country:US
Mailing Address - Phone:630-981-7456
Mailing Address - Fax:
Practice Address - Street 1:3417 EVANSTON AVE N STE 309
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8967
Practice Address - Country:US
Practice Address - Phone:346-298-1093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60792355101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health