Stacey Park, PHD
Individual provider Active NPI Clinical Child & Adolescent Psychologist · Fircrest, WA
NPI 1659801173 · NPPES record last updated Jun 25, 2022
Key facts
- NPI
- 1659801173
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Child & Adolescent Psychologist 103TC2200X
- License
- PY60880262 (WA)
- Practice address
- 6314 19TH St W Ste 14
Fircrest, WA 98466-6223 - Phone
- (253) 239-2310
- Fax
- (253) 239-2311
- NPI assigned
- Jun 18, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY60880262 | WA | MD | Clinical Child & Adolescent Psychologist |
| 28774 | CA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Child Psychology Testing Services PLLC | Clinical Child & Adolescent | Current |
Accepting new patients |
| Select Services by Ops, PLLC | Past |
Accepting new patients | |
| Olympic Psychology Services, PLLC | Past |
Accepting new patients |
Locations
6314 19th St W
Ste 14
Fircrest, WA 98466
Phone (253) 239-2310
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | PY60880262 | WA | Yes |
| Counseling Psychologist | 103TC1900X | 28774 | CA |
Addresses
Primary practice location
6314 19TH St W Ste 14
Fircrest, WA 98466-6223
Mailing address
6314 19TH St W Ste 14
Fircrest, WA 98466-6223
Other providers in Fircrest, WA
- Elijah Occenola
- Tina M. Olsson
- Optimum Physical Therapy, LLC
- Heidi Miranda Ormbrek
- Michelle Ost
- Aaron Thomas Pascoe
- Carla Pedey
- Kariah C Phillips
- Zaccary John E Pincock
- Kathleen Pizzolatto
All providers in Fircrest, WA · Clinical Child & Adolescent Psychologist in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 25, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.