Provider Demographics
NPI:1740535863
Name:ROACHE, STEFFANNIE (LPC)
Entity type:Individual
Prefix:MS
First Name:STEFFANNIE
Middle Name:
Last Name:ROACHE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6507 68TH ST NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-5346
Mailing Address - Country:US
Mailing Address - Phone:971-717-2307
Mailing Address - Fax:866-959-3177
Practice Address - Street 1:985 NE 24TH ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-2905
Practice Address - Country:US
Practice Address - Phone:503-333-3306
Practice Address - Fax:866-959-3177
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3929101YP2500X
101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor