Provider Demographics
NPI:1366951527
Name:WAYE, STEPHEN DALE (LMFT)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:DALE
Last Name:WAYE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 184
Mailing Address - Street 2:
Mailing Address - City:WELLS RIVER
Mailing Address - State:VT
Mailing Address - Zip Code:05081-0184
Mailing Address - Country:US
Mailing Address - Phone:802-304-8394
Mailing Address - Fax:
Practice Address - Street 1:1097 MAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-2646
Practice Address - Country:US
Practice Address - Phone:802-304-8394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT100.0134068106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist