Healthcare Provider Details

I. General information

NPI: 1740537117
Provider Name (Legal Business Name): STEPHANIE ERIN DALE BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE ERIN BLOOMFIELD BCBA

II. Dates (important events)

Enumeration Date: 08/05/2012
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29390 QUAIL RUN DR
AGOURA HILLS CA
91301-1565
US

IV. Provider business mailing address

6011 KERRMOOR DR
WESTLAKE VILLAGE CA
91362-4122
US

V. Phone/Fax

Practice location:
  • Phone: 310-429-7214
  • Fax:
Mailing address:
  • Phone: 310-429-7214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number1-11-9008
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: