Provider Demographics
NPI:1184057572
Name:STANFORD, DEBIRUTH (LMHC, MA)
Entity type:Individual
Prefix:MS
First Name:DEBIRUTH
Middle Name:
Last Name:STANFORD
Suffix:
Gender:F
Credentials:LMHC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 LAKE BELLEVUE DR STE 214
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2454
Mailing Address - Country:US
Mailing Address - Phone:425-329-8249
Mailing Address - Fax:425-699-0468
Practice Address - Street 1:16802 NE 30TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-2129
Practice Address - Country:US
Practice Address - Phone:425-785-8354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60174962101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health