Provider Demographics
NPI:1245463553
Name:MCLEAN, STACIE AE (LMHCA)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:AE
Last Name:MCLEAN
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 1:1708 197TH AVENUE KP S
Mailing Address - Street 2:
Mailing Address - City:LAKEBAY
Mailing Address - State:WA
Mailing Address - Zip Code:98349-8111
Mailing Address - Country:US
Mailing Address - Phone:253-245-9221
Mailing Address - Fax:855-269-3268
Practice Address - Street 1:6712 KIMBALL DR
Practice Address - Street 2:#103
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1212
Practice Address - Country:US
Practice Address - Phone:253-245-9221
Practice Address - Fax:855-269-3268
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60210748101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health