Healthcare Provider Details

I. General information

NPI: 1912308818
Provider Name (Legal Business Name): STEPHAN HARRISON SALTER MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 S LEWIS RD EDUCATION
CAMARILLO CA
93012-8520
US

IV. Provider business mailing address

1722 S LEWIS RD EDUCATION
CAMARILLO CA
93012-8520
US

V. Phone/Fax

Practice location:
  • Phone: 805-366-4072
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number117314
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: