Healthcare Provider Details

I. General information

NPI: 1780332924
Provider Name (Legal Business Name): STEPHANIE FLOOD MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2183 LA MIEL WAY
CAMPBELL CA
95008-2663
US

IV. Provider business mailing address

2183 LA MIEL WAY
CAMPBELL CA
95008-2663
US

V. Phone/Fax

Practice location:
  • Phone: 508-904-0846
  • Fax:
Mailing address:
  • Phone: 508-904-0846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number52873
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number52873
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: