Healthcare Provider Details

I. General information

NPI: 1427324649
Provider Name (Legal Business Name): STEPHANIE M MUSTOPICH LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2606 1/2 3RD AVE
SEATTLE WA
98121-1214
US

IV. Provider business mailing address

2606 1/2 3RD AVE
SEATTLE WA
98121-1214
US

V. Phone/Fax

Practice location:
  • Phone: 541-887-0586
  • Fax:
Mailing address:
  • Phone: 541-887-0586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF60791690
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: