MEDICARE: MRS. STEPHANIE BETH HALVORSEN PARRISH MFTA, CDP

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	CP 60662076	WA
2	106H00000X	Marriage & Family Therapist	MG 60662044	WA

General Provider Information

NPI Number	:	1598297442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE BETH HALVORSEN PARRISH MFTA, CDP

Provider Business Mailing Address
First Line	:	1912 W 18TH ST
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98363-5121
Country	:	US
Telephone Number	:	360-565-2648
Fax Number	:	360-457-4875

Provider Business Practice Location Address
First Line	:	1912 W 18TH ST
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98363-5121
Country	:	US
Telephone Number	:	360-565-2648
Fax Number	:	360-457-4875

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

Provider Enumeration Date	:	03/30/2017
Last Update Date	:	03/30/2017

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