Healthcare Provider Details

I. General information

NPI: 1952056491
Provider Name (Legal Business Name): CHRISTINA JEAN STCLAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 KOALA DR
OMAK WA
98841-9247
US

IV. Provider business mailing address

1007 KOALA DR
OMAK WA
98841-9247
US

V. Phone/Fax

Practice location:
  • Phone: 509-826-6191
  • Fax: 509-826-3029
Mailing address:
  • Phone: 509-826-6191
  • Fax: 509-826-3029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCG61156676
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCG61156676
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC.70130546
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: