Healthcare Provider Details

I. General information

NPI: 1922929140
Provider Name (Legal Business Name): STACY WORLEY LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W NORTH BEND WAY STE 100C
NORTH BEND WA
98045-8163
US

IV. Provider business mailing address

234 BENDIGO BLVD N UNIT A
NORTH BEND WA
98045-8259
US

V. Phone/Fax

Practice location:
  • Phone: 601-807-8100
  • Fax:
Mailing address:
  • Phone: 601-807-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHCA.MC.70121958
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: