Provider Demographics
NPI:1962905844
Name:MACIE STEAD
Entity type:Organization
Organization Name:MACIE STEAD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEAD
Authorized Official - Suffix:
Authorized Official - Credentials:BA, MS, LMHC, CMHS
Authorized Official - Phone:509-964-5715
Mailing Address - Street 1:2013 W 4TH AVE # 2
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-7601
Mailing Address - Country:US
Mailing Address - Phone:509-964-5715
Mailing Address - Fax:
Practice Address - Street 1:2013 W 4TH AVE # 2
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-7601
Practice Address - Country:US
Practice Address - Phone:509-964-5715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60515883251B00000X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No251B00000XAgenciesCase Management
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health