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General NPI Number Information
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NPI Number | 1538698147
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Entity Type | Individual
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Provider Name | STANLEY D KOLPAK II PHD
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Gender | Male
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Dates
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Enumeration Date | 06/07/2017
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Last Update Date | 08/12/2024
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Provider Practice Location Address
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Address Line | 604 N 13TH ST
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City | ELMA
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State | WA
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Zip | 98541-9330
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Country | US
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Telephone | 360-470-4277
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Fax | 360-532-8786
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Provider Business Mailing Address
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Address Line | 604 N 13TH ST
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City | ELMA
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State | WA
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Zip | 98541-9330
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Country | US
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Telephone | 360-470-4277
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Fax | 360-532-8786
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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 | LF61513857
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH1211688
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License Number State | WA
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