Provider Demographics
NPI:1194886218
Name:STOCKMAN, JERALD HENRY (MS, LMFT)
Entity type:Individual
Prefix:MR
First Name:JERALD
Middle Name:HENRY
Last Name:STOCKMAN
Suffix:
Gender:M
Credentials:MS, LMFT
Other - Prefix:MR
Other - First Name:JERRY
Other - Middle Name:
Other - Last Name:STOCKMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LMFT
Mailing Address - Street 1:6511 150TH PL SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-5027
Mailing Address - Country:US
Mailing Address - Phone:425-562-8005
Mailing Address - Fax:425-746-2021
Practice Address - Street 1:6511 150TH PL SE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-5027
Practice Address - Country:US
Practice Address - Phone:425-562-8005
Practice Address - Fax:425-746-2021
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00000965106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALF00000965OtherSTATE LICENSURE