Healthcare Provider Details

I. General information

NPI: 1629078373
Provider Name (Legal Business Name): CHRISTOPHER CHARLES STAEHELI M.D.J.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4422 6TH AVE SE
LACEY WA
98503-1020
US

IV. Provider business mailing address

2909 N 25TH ST
TACOMA WA
98406-7105
US

V. Phone/Fax

Practice location:
  • Phone: 360-236-7199
  • Fax: 360-412-4982
Mailing address:
  • Phone: 253-503-6001
  • Fax: 360-412-4982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number80222
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD00026193
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: