Individual
DR. STACEY PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
6314 19TH ST W STE 14, FIRCREST, WA 98466-6223
(253) 239-2310
(253) 239-2311
Mailing address
6314 19TH ST W STE 14, FIRCREST, WA 98466-6223
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
28774
CA
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PY60880262
WA
Other
Enumeration date
06/18/2017
Last updated
06/25/2022
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