Provider Demographics
NPI:1336559111
Name:STANFORD, MIIK WELLS JR
Entity type:Individual
Prefix:MR
First Name:MIIK
Middle Name:WELLS
Last Name:STANFORD
Suffix:JR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MIIK
Other - Middle Name:WELLS
Other - Last Name:DEL OCEANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6159
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-0159
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14434 NE 8TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-4105
Practice Address - Country:US
Practice Address - Phone:425-502-5018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst