Provider Demographics
NPI:1063069532
Name:STALEY, ALBERT AGUSTAV (BS, LMHC-A)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:AGUSTAV
Last Name:STALEY
Suffix:
Gender:M
Credentials:BS, LMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 W LONGFELLOW AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-1852
Mailing Address - Country:US
Mailing Address - Phone:509-312-7482
Mailing Address - Fax:
Practice Address - Street 1:3707 W LONGFELLOW AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-1852
Practice Address - Country:US
Practice Address - Phone:509-312-7482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61402028101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health