Provider Demographics
NPI:1386846046
Name:PISANO, STACY SCHILTER (MA, LMFT, CEDS)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:SCHILTER
Last Name:PISANO
Suffix:
Gender:F
Credentials:MA, LMFT, CEDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5509 KOMACHIN LOOP SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98513-6524
Mailing Address - Country:US
Mailing Address - Phone:360-440-0607
Mailing Address - Fax:
Practice Address - Street 1:924 7TH AVE SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1548
Practice Address - Country:US
Practice Address - Phone:360-440-0607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YA0400X, 101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health