Provider Demographics
NPI:1487104253
Name:CARL, STEPHANIE ERICKSON (LMHC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ERICKSON
Last Name:CARL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2027 196TH ST SW STE A205
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-7073
Mailing Address - Country:US
Mailing Address - Phone:425-202-6005
Mailing Address - Fax:425-367-0531
Practice Address - Street 1:2027 196TH ST SW STE A205
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-7073
Practice Address - Country:US
Practice Address - Phone:425-202-6005
Practice Address - Fax:425-367-0531
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2211204Medicaid