Provider Demographics
NPI:1295179430
Name:STOOPS, SANDY L (AAC)
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:L
Last Name:STOOPS
Suffix:
Gender:F
Credentials:AAC
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:L
Other - Last Name:BRUHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3713 PACIFIC AVE STE E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418-7845
Mailing Address - Country:US
Mailing Address - Phone:253-433-7993
Mailing Address - Fax:253-540-6886
Practice Address - Street 1:505 29TH ST SE
Practice Address - Street 2:CHARTLEY HOUSE
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-7541
Practice Address - Country:US
Practice Address - Phone:253-876-7650
Practice Address - Fax:253-876-7651
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60290321101Y00000X, 101YM0800X
106S00000X
WA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician