Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | MC60197538 | WA |
Y | 102L00000X | Psychologist | PY60447862 | WA |
Y | 103T00000X | Psychologist | PY60447862 | WA |
NPI | 1013218767 |
---|---|
Provider Name | Dr. Justin Steffener |
First Address | Everett, WA 98206-5127 |
Second Address | Mill Creek, WA 98012-9030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2010 |
Last Update Date | 14/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2061671 | (05) | WA |