MEDICARE: MISS STACY JURGENS LMHCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	50139	CA
2	101YM0800X	Mental Health Counselor	MC70015753	WA

General Provider Information

NPI Number	:	1598800856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS STACY JURGENS LMHCA

Provider Business Mailing Address
First Line	:	350 S 38TH CT STE 210
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98055-5777
Country	:	US
Telephone Number	:	253-752-7320
Fax Number	:	253-276-6624

Provider Business Practice Location Address
First Line	:	350 S 38TH CT STE 210
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98055-5777
Country	:	US
Telephone Number	:	253-752-7320
Fax Number	:	253-276-6624

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	11/21/2025

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