Provider Demographics
NPI:1053996884
Name:STACIE J. WEBB, LICSW, PLLC
Entity type:Organization
Organization Name:STACIE J. WEBB, LICSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:509-570-4098
Mailing Address - Street 1:5815 W SHAWNEE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-9348
Mailing Address - Country:US
Mailing Address - Phone:509-570-4098
Mailing Address - Fax:
Practice Address - Street 1:9631 N NEVADA ST STE 209
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1197
Practice Address - Country:US
Practice Address - Phone:509-570-4098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health