MEDICARE: STEPHANIE JORDAN MRAKOVICH LMHCA

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	MC60792355	WA

General Provider Information

NPI Number	:	1881180610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE JORDAN MRAKOVICH LMHCA

Provider Business Mailing Address
First Line	:	2484 DEXTER AVE N APT 2
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98109-2245
Country	:	US
Telephone Number	:	630-981-7456
Fax Number	:

Provider Business Practice Location Address
First Line	:	3417 EVANSTON AVE N STE 309
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-8967
Country	:	US
Telephone Number	:	346-298-1093
Fax Number	:

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

Provider Enumeration Date	:	07/05/2018
Last Update Date	:	07/05/2018

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