Healthcare Provider Details

I. General information

NPI: 1710594585
Provider Name (Legal Business Name): TRISHA STAHLEY AAC, CPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 COMMERCE AVENUE
LONGVIEW WA
98632
US

IV. Provider business mailing address

PO BOX 2394
LONGVIEW WA
98632
US

V. Phone/Fax

Practice location:
  • Phone: 360-998-2047
  • Fax: 360-200-6736
Mailing address:
  • Phone: 360-200-5419
  • Fax: 360-200-6736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number61109299
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number61109299
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: