Provider Demographics
NPI:1427439264
Name:STANLEY, TIM LEE (LMHCA)
Entity type:Individual
Prefix:MR
First Name:TIM
Middle Name:LEE
Last Name:STANLEY
Suffix:
Gender:M
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1937 9TH AVE W
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-2819
Mailing Address - Country:US
Mailing Address - Phone:770-843-0382
Mailing Address - Fax:
Practice Address - Street 1:7220 WOODLAWN AVE NE
Practice Address - Street 2:SUITE #305
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5336
Practice Address - Country:US
Practice Address - Phone:770-843-0382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60487260101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health