Healthcare Provider Details

I. General information

NPI: 1295179430
Provider Name (Legal Business Name): SANDY L STOOPS AAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA L BRUHN

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 29TH ST SE CHARTLEY HOUSE
AUBURN WA
98002-7541
US

IV. Provider business mailing address

3713 PACIFIC AVE STE E
TACOMA WA
98418-7845
US

V. Phone/Fax

Practice location:
  • Phone: 253-876-7650
  • Fax: 253-876-7651
Mailing address:
  • Phone: 253-433-7993
  • Fax: 253-540-6886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG60290321
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCG60290321
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: