Provider Demographics
NPI:1083349906
Name:STAFFORD, KADY (LPC)
Entity type:Individual
Prefix:MS
First Name:KADY
Middle Name:
Last Name:STAFFORD
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13574 SW HIGHWAY 126
Mailing Address - Street 2:
Mailing Address - City:POWELL BUTTE
Mailing Address - State:OR
Mailing Address - Zip Code:97753-1541
Mailing Address - Country:US
Mailing Address - Phone:541-480-6360
Mailing Address - Fax:
Practice Address - Street 1:6396 SW MCVEY AVE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-9069
Practice Address - Country:US
Practice Address - Phone:541-203-0307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-24
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC6225101YP2500X
ORC9084101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional