DR. STACEY PARK (NPI# 1659801173) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659801173 |
| Entity Type | Individual |
| Full Name | DR. STACEY PARK |
| Credential | PHD |
| Practice Address |
711 Court A Ste 114 Tacoma WA 98402-5227 |
| Practice Telephone | 2532696063 |
| Mailing Telephone | 2532696063 |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2019-06-01 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TC1900X |
Psychologist Specialization: Counseling |
28774 | CA | Behavioral Health & Social Service Providers |
| Y | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
PY60880262 | WA | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3505 Broadway Fl 4, Oakland, CA 946115714 | 5107528298 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427482983 | Stacey Park | Pharmacist | 5688 Telephone Rd, Ventura, CA 93003-5326 | 2013-09-02 |
| Street Address |
711 COURT A STE 114 |
| City | TACOMA |
| State | WA |
| Zip Code | 98402-5227 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497114342 | Olympic Psychology Services, Pllc | Community/Behavioral Health | 711 Court A Ste 114, Tacoma, WA 98402-5227 | 2016-02-22 |
| 1609399054 | Cynthia Swanlund | Psychologist | 711 Court A Ste 114, Tacoma, WA 98402-5227 | 2017-07-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548898638 | Cimberleigh Mclean | Social Worker | 2367 Tacoma Ave S Ofc 211, Tacoma, WA 98402 | 2020-04-01 |
| 1831735802 | Nickolas Justin Wise | Case Manager/Care Coordinator | 1159 Market St, Tacoma, WA 98402 | 2019-11-25 |
| 1841835436 | Michael Roy Bolden | Counselor | 1205 Tacoma Ave S., Suite 1205, Tacoma, WA 98402 | 2019-11-07 |
| 1073024980 | Megan Elizabeth Charron Mourfield | Denturist | 725 St Helens Ave S, Tacoma, WA 98402 | 2017-10-18 |
| 1104367937 | Janelle Santiago | Counselor | Mcdonald Smith Building 110, Uw Autism Center Tacoma, Tacoma, WA 98402 | 2017-03-13 |
| 1891167862 | Tanya Larson Therapy | Community/Behavioral Health | 1102 A. St., Suite 109, (suite 109), Tacoma, WA 98402 | 2015-10-29 |
| 1609242148 | Ashley Lorraine Dahlgren | Peer Specialist | 702 S 14th St., Tacoma, WA 98402 | 2015-08-19 |
| 1821416470 | Nicole Villarreal Mccormick | Acupuncturist | 711 A Ct #100, Tacoma, WA 98402 | 2014-04-01 |
| 1184055824 | Robyn Marie Callahan | Social Worker | 1102 A Street, Suite 202 B, Tacoma, WA 98402 | 2013-12-05 |
| 1679909410 | Kristin Sweet Fischer | Counselor | 708 Market St Unit 411, Tacoma, WA 98402 | 2013-09-25 |
| Find all providers in zip 98402 | ||||
| Taxonomy Code | 103TC2200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical Child & Adolescent |
| Definition to come... |
| Notes: [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962588616 | Kenneth A Miles | Psychologist | Madigan Army Medical Center Attn: Kenneth A Miles, Ph.d, 9040 Jackson Ave, Tacoma, WA 98431 | 2006-10-27 |
| 1477194173 | Isabelle Oh | Psychologist | 1220 Division Ave, Tacoma, WA 98403-1321 | 2019-10-03 |
| 1811225584 | Diana Marie Frey | Psychologist | 9040 Jackson Ave, Tacoma, WA 98431 | 2009-11-18 |
| 1134349616 | Rebekah A Cline | Psychologist | 1530 S Union Ave, Suite 16, Tacoma, WA 98405-1954 | 2007-04-26 |
| 1265560106 | Allison Mckinzie Osborn | Psychologist | 1530 S Union Ave Ste 1, Tacoma, WA 98405-1954 | 2007-03-01 |
| 1649326554 | Barry Stuart Anton | Psychologist | 5909 Orchard St W, Tacoma, WA 98467-3824 | 2007-01-25 |
| 1710039631 | Bradley I. Steinfeld | Psychologist | 4301 S Pine St, Ste 301, Tacoma, WA 98409-7264 | 2007-01-18 |
| 1134169261 | Elizabeth Mae Anderson | Psychologist | Madigan Army Medical Center 9040 Jackson Avenue, Tacoma, WA 98431-4816 | 2006-06-07 |
| 1407824386 | Steven Charles Parkison | Psychologist | Madigan Army Medical Center, 9040 A. Fitzsimmons Dr., Tacoma, WA 98431-0001 | 2006-03-08 |
| 1386611606 | Monica M Van Hoomissen | Psychologist | 1530 S Union Ave, Suite 8, Tacoma, WA 98405-1954 | 2006-03-06 |
| Find all providers in TACOMA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.