Provider Demographics
NPI:1275122046
Name:BADDELEY, STEPHEN (CCC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:BADDELEY
Suffix:
Gender:M
Credentials:CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 14TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-6602
Mailing Address - Country:US
Mailing Address - Phone:425-999-1905
Mailing Address - Fax:
Practice Address - Street 1:1001 C ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-3933
Practice Address - Country:US
Practice Address - Phone:360-559-2903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-15
Last Update Date:2024-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACCC.CL.61482118101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health