Provider Demographics
NPI:1962550681
Name:STAAL, DONALD E (MA,CDP,LMFT)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:E
Last Name:STAAL
Suffix:
Gender:M
Credentials:MA,CDP,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 463
Mailing Address - Street 2:
Mailing Address - City:CUSTER
Mailing Address - State:WA
Mailing Address - Zip Code:98240-0463
Mailing Address - Country:US
Mailing Address - Phone:360-332-1000
Mailing Address - Fax:360-332-1005
Practice Address - Street 1:228 CHERRY ST
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:WA
Practice Address - Zip Code:98230-5017
Practice Address - Country:US
Practice Address - Phone:360-332-1000
Practice Address - Fax:360-332-1005
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALMFT #1553106H00000X
WALF00001553101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist