Individual
AUDRA STAVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13501 NE 28TH ST, VANCOUVER, WA 98682
(360) 604-6700
Mailing address
PO BOX 8910, VANCOUVER, WA 98668-8910
(360) 604-6700
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
PY60794634
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/03/2014
Last updated
08/07/2018
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