Provider Demographics
NPI:1447841820
Name:STEPHANIE GIDDINGS LMFT INC
Entity type:Organization
Organization Name:STEPHANIE GIDDINGS LMFT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIDDINGS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:971-599-2251
Mailing Address - Street 1:4676 COMMERCIAL ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-1902
Mailing Address - Country:US
Mailing Address - Phone:971-599-2251
Mailing Address - Fax:
Practice Address - Street 1:4335 REDING WAY
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-4481
Practice Address - Country:US
Practice Address - Phone:971-599-2251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500704895Medicaid