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General NPI Number Information
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NPI Number | 1366951527
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Entity Type | Individual
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Provider Name | STEPHEN DALE WAYE LMFT
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Gender | Male
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Dates
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Enumeration Date | 09/20/2017
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Last Update Date | 11/15/2023
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Provider Practice Location Address
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Address Line | 1097 MAIN ST
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City | SAINT JOHNSBURY
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State | VT
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Zip | 05819-2646
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Country | US
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Telephone | 802-304-8394
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 184
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City | WELLS RIVER
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State | VT
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Zip | 05081-0184
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Country | US
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Telephone | 802-304-8394
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 100.0134068
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License Number State | VT
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