Healthcare Provider Details

I. General information

NPI: 1427664077
Provider Name (Legal Business Name): STEPHANIE JUSTUS LMFTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9930 EVERGREEN WAY STE Z150
EVERETT WA
98204-3889
US

IV. Provider business mailing address

9930 EVERGREEN WAY STE Z150
EVERETT WA
98204-3889
US

V. Phone/Fax

Practice location:
  • Phone: 425-347-5121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMG61088602
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: