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General NPI Number Information
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NPI Number | 1609185271
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Entity Type | Organization
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Legal Business Name | STACEY E PRINCE PHD PS
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Dates
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Enumeration Date | 09/30/2010
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Last Update Date | 08/18/2018
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Provider Practice Location Address
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Address Line | 2207 NE 65TH ST STE 200
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City | SEATTLE
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State | WA
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Zip | 98115
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Country | US
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Telephone | 206-898-0010
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Fax |
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Provider Business Mailing Address
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Address Line | 2207 NE 65TH ST STE 200
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City | SEATTLE
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State | WA
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Zip | 98115-7097
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Country | US
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Telephone | 206-898-0010
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STACEY E PRINCE
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Credential | PHD
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Telephone | 206-898-0010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 00002535
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License Number State | WA
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