Basic Information
| Provider Information | |||||||||
| NPI: | 1205097805 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STOCKLY | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | BA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9330 59TH AVE SW | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984992858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535817020 | ||||||||
| FaxNumber: | 2536205831 | ||||||||
| Practice Location | |||||||||
| Address1: | 9330 59TH AVE SW | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984992858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535817020 | ||||||||
| FaxNumber: | 2536205831 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2008 | ||||||||
| LastUpdateDate: | 06/17/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | RC00060505 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.