MEDICARE: NICOLETTE STENGER LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CO 60581151	WA
2	101YM0800X	Mental Health Counselor	MCHA.MC.60583575	WA
3	106H00000X	Marriage & Family Therapist	#MG 60562324	WA
4	106H00000X	Marriage & Family Therapist	LF60739153	WA

General Provider Information

NPI Number	:	1144675976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLETTE STENGER LMFT

Provider Business Mailing Address
First Line	:	4501 15TH AVE S STE 103
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98108-1874
Country	:	US
Telephone Number	:	206-580-3158
Fax Number	:

Provider Business Practice Location Address
First Line	:	4501 15TH AVE S STE 103
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98108-1874
Country	:	US
Telephone Number	:	206-580-3158
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2016
Last Update Date	:	11/18/2020

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