Healthcare Provider Details

I. General information

NPI: 1033076203
Provider Name (Legal Business Name): WILLIAM STALLWORTH MS, PPS, AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36300 FREMONT BLVD
FREMONT CA
94536-3511
US

IV. Provider business mailing address

36300 FREMONT BLVD
FREMONT CA
94536-3511
US

V. Phone/Fax

Practice location:
  • Phone: 510-796-1776
  • Fax:
Mailing address:
  • Phone: 510-796-1776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number128044
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number210136286
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: