Provider Demographics
NPI:1427324649
Name:MUSTOPICH, STEPHANIE M (LMFT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:MUSTOPICH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 1/2 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-1214
Mailing Address - Country:US
Mailing Address - Phone:541-887-0586
Mailing Address - Fax:
Practice Address - Street 1:2606 1/2 3RD AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-1214
Practice Address - Country:US
Practice Address - Phone:541-887-0586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
WALF60791690106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No174400000XOther Service ProvidersSpecialist