MEDICARE: STANLEY ANTHONY LEMELLE LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	LMFT41777	CA

General Provider Information

NPI Number	:	1770075657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STANLEY ANTHONY LEMELLE LMFT

Provider Business Mailing Address
First Line	:	11780 CENTRAL AVE STE 100
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-6499
Country	:	US
Telephone Number	:	909-517-2020
Fax Number	:	909-517-2022

Provider Business Practice Location Address
First Line	:	11780 CENTRAL AVE STE 100
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-6499
Country	:	US
Telephone Number	:	909-517-2020
Fax Number	:	909-517-2022

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2018
Last Update Date	:	06/11/2019

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