Provider Demographics
NPI:1982901468
Name:PHILLIPS, STEPHANIE (LMHCA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:PHILLIPS
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 1:1811 QUEEN ANNE AVE N STE 202
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-2850
Mailing Address - Country:US
Mailing Address - Phone:206-658-3527
Mailing Address - Fax:206-337-2418
Practice Address - Street 1:1811 QUEEN ANNE AVE N STE 202
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-2850
Practice Address - Country:US
Practice Address - Phone:206-658-3527
Practice Address - Fax:206-337-2418
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-18
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL60186116101Y00000X
WAMC60288344101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor