Provider Demographics
NPI:1124458948
Name:STEAD, MACIE ANN (LMHC, NCC, MS)
Entity type:Individual
Prefix:
First Name:MACIE
Middle Name:ANN
Last Name:STEAD
Suffix:
Gender:F
Credentials:LMHC, NCC, MS
Other - Prefix:
Other - First Name:MACIE
Other - Middle Name:ANN
Other - Last Name:BREACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, NCC, QSUDPT
Mailing Address - Street 1:107 S DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1510
Mailing Address - Country:US
Mailing Address - Phone:509-838-4651
Mailing Address - Fax:509-363-2762
Practice Address - Street 1:107 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202
Practice Address - Country:US
Practice Address - Phone:509-838-4651
Practice Address - Fax:509-363-2762
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5418101YM0800X
WALH60515883101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1124458948Medicaid