Healthcare Provider Details

I. General information

NPI: 1205304011
Provider Name (Legal Business Name): STACEY ANNE OKIHARA MED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STACEY A SAWCJERS

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 E 3RD AVE
SPOKANE WA
99202-2211
US

IV. Provider business mailing address

107 S DIVISION ST
SPOKANE WA
99202-1510
US

V. Phone/Fax

Practice location:
  • Phone: 509-838-4651
  • Fax:
Mailing address:
  • Phone: 509-838-4651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG60152604
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61020751
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: