MEDICARE: CRAIG STULL MA

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	101YM0800X	Mental Health Counselor	LH00003470	WA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	CP00003175	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CP00003175	OTHER	WA	CHEMICAL DEPENDENCY PROF
2	LH00003470	OTHER	WA	LICENSED MH COUNSELOR

General Provider Information

NPI Number	:	1689677114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG STULL MA

Provider Business Mailing Address
First Line	:	2628 MARINE AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-2816
Country	:	US
Telephone Number	:	206-329-1660
Fax Number	:

Provider Business Practice Location Address
First Line	:	1127 10TH AVE E
Second Line	:	STE 7
City	:	SEATTLE
State	:	WA
Zip	:	98102-4377
Country	:	US
Telephone Number	:	206-329-1660
Fax Number	:

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

Provider Enumeration Date	:	05/30/2005
Last Update Date	:	09/11/2025

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Directions to “ CRAIG STULL MA” Practice Location

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