Healthcare Provider Details

I. General information

NPI: 1881180610
Provider Name (Legal Business Name): STEPHANIE JORDAN MRAKOVICH LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3417 EVANSTON AVE N STE 309
SEATTLE WA
98103-8967
US

IV. Provider business mailing address

2484 DEXTER AVE N APT 2
SEATTLE WA
98109-2245
US

V. Phone/Fax

Practice location:
  • Phone: 346-298-1093
  • Fax:
Mailing address:
  • Phone: 630-981-7456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC60792355
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: