Healthcare Provider Details

I. General information

NPI: 1538414768
Provider Name (Legal Business Name): RENEE FLOURNOY STOKMAN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 07/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 KNOTT AVE
BUENA PARK CA
90620-1314
US

IV. Provider business mailing address

PO BOX 7152
FULLERTON CA
92834-7152
US

V. Phone/Fax

Practice location:
  • Phone: 714-562-0406
  • Fax:
Mailing address:
  • Phone: 714-446-8836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number51608
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: