Provider Demographics
NPI:1306812169
Name:SWEENEY, JODY FAY (MS, LMHC, NCC, CSP)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:FAY
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:MS, LMHC, NCC, CSP
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:MARIE
Other - Last Name:FAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LMHC, NCC, CSP
Mailing Address - Street 1:1124 W RIVERSIDE AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-1132
Mailing Address - Country:US
Mailing Address - Phone:509-455-8819
Mailing Address - Fax:509-455-8903
Practice Address - Street 1:1124 W RIVERSIDE AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-1132
Practice Address - Country:US
Practice Address - Phone:509-455-8819
Practice Address - Fax:509-455-8903
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00007965101YM0800X
69882101YM0800X
WA420895E103TS0200X
WA1167925146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Not Answered146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic