Provider Demographics
NPI:1174272090
Name:TUMBA, STEPHANIE MAE (MC61119663)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MAE
Last Name:TUMBA
Suffix:
Gender:F
Credentials:MC61119663
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:MAE
Other - Last Name:COOKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3206 W GARLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-2231
Mailing Address - Country:US
Mailing Address - Phone:951-455-5508
Mailing Address - Fax:
Practice Address - Street 1:3206 W GARLAND AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-2231
Practice Address - Country:US
Practice Address - Phone:951-455-5508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61119663101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health