Provider Demographics
NPI:1962949164
Name:MCWETHY, STEPHANIE (LMFT-S, CMHS, EMMHS)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MCWETHY
Suffix:
Gender:F
Credentials:LMFT-S, CMHS, EMMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19730 64TH AVE W STE 321
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5957
Mailing Address - Country:US
Mailing Address - Phone:509-823-1616
Mailing Address - Fax:360-326-0431
Practice Address - Street 1:19730 64TH AVE W STE 321
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5957
Practice Address - Country:US
Practice Address - Phone:509-823-1616
Practice Address - Fax:360-326-0431
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60077794106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist