Healthcare Provider Details

I. General information

NPI: 1821492190
Provider Name (Legal Business Name): STEPHANIE HUGHES BOAK M.ED, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2014
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 E 25TH STREET NW FAMILY PSYCHOLOGY, LLC
VANCOUVER WA
98663-3129
US

IV. Provider business mailing address

208 E 25TH STREET NW FAMILY PSYCHOLOGY, LLC
VANCOUVER WA
98663-3129
US

V. Phone/Fax

Practice location:
  • Phone: 360-910-1522
  • Fax: 360-326-1522
Mailing address:
  • Phone: 360-910-1522
  • Fax: 360-326-1522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLN60705301
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: