Active NPI
Lydiana Maribel Mendez-Stafford, CAAR
- Counselor
- Centralia, WA
National Provider Identifier
1477320372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- CG61509358
- Practice address
- 2428 W Reynolds Ave
Centralia, WA 98531-4554 - Phone
- (360) 330-9044
- Fax
- (360) 237-5675
- NPI assigned
- Dec 11, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | CG61509358 | WA | Primary |
Addresses
Primary practice location
2428 W Reynolds Ave
Centralia, WA 98531-4554
Mailing address
2428 W Reynolds Ave
Centralia, WA 98531-4554
Phone (360) 330-9044
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CG61509358 | WA | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1702252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1702252800000",
"number": "1477320372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2428 W REYNOLDS AVE",
"city": "CENTRALIA",
"state": "WA",
"postal_code": "985314554",
"telephone_number": "360-330-9044",
"fax_number": "360-237-5675"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2428 W REYNOLDS AVE",
"city": "CENTRALIA",
"state": "WA",
"postal_code": "985314554",
"telephone_number": "360-330-9044",
"fax_number": "360-237-5675"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENDEZ-STAFFORD",
"first_name": "LYDIANA",
"middle_name": "MARIBEL",
"credential": "CAAR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-12-11",
"last_updated": "2023-12-11",
"certification_date": "2023-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WA",
"license": "CG61509358",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Centralia, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.