Provider Demographics
NPI:1285917682
Name:HANNIGAN, STACEY (LMHC)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:HANNIGAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12003 N DAKOTA LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-3615
Mailing Address - Country:US
Mailing Address - Phone:509-350-7690
Mailing Address - Fax:
Practice Address - Street 1:12003 N DAKOTA LN
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-3615
Practice Address - Country:US
Practice Address - Phone:509-218-8545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60412589101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health