Provider Demographics
NPI:1649616269
Name:GAJEWSKI, STEPHEN W (LPC, MSC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:W
Last Name:GAJEWSKI
Suffix:
Gender:M
Credentials:LPC, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 DOUGLASS AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4313
Mailing Address - Country:US
Mailing Address - Phone:509-521-7457
Mailing Address - Fax:208-287-9426
Practice Address - Street 1:2448 N MERRITT CREEK LOOP
Practice Address - Street 2:SUITE 2E
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-6215
Practice Address - Country:US
Practice Address - Phone:509-521-7457
Practice Address - Fax:208-287-9426
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC 5180101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health