Healthcare Provider Details

I. General information

NPI: 1710451638
Provider Name (Legal Business Name): STEPHANIE AFI HOUNNOU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE AFI MUTCHLER LCSW

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 10/12/2026
Certification Date: 10/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 WILSHIRE BLVD FL 19
LOS ANGELES CA
90048-4920
US

IV. Provider business mailing address

6500 WILSHIRE BLVD FL 19
LOS ANGELES CA
90048-4920
US

V. Phone/Fax

Practice location:
  • Phone: 805-764-9651
  • Fax: 747-330-1670
Mailing address:
  • Phone: 805-764-9651
  • Fax: 747-330-1670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number110112
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149026152
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: