Provider Demographics
NPI:1457986705
Name:GEORGE, STACY MICHELLE KEOGH
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:MICHELLE KEOGH
Last Name:GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17605 N KIMBERLY RD
Mailing Address - Street 2:
Mailing Address - City:COLBERT
Mailing Address - State:WA
Mailing Address - Zip Code:99005-9287
Mailing Address - Country:US
Mailing Address - Phone:509-850-5323
Mailing Address - Fax:
Practice Address - Street 1:9507 N DIVISION ST STE A
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1556
Practice Address - Country:US
Practice Address - Phone:509-466-6632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist