Healthcare Provider Details

I. General information

NPI: 1265014542
Provider Name (Legal Business Name): STANISHA YORK LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 HEACOCK ST STE C238
MORENO VALLEY CA
92553-6268
US

IV. Provider business mailing address

30141 ANTELOPE RD # D-666
MENIFEE CA
92584-7001
US

V. Phone/Fax

Practice location:
  • Phone: 951-398-6009
  • Fax:
Mailing address:
  • Phone: 909-510-1584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17575
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: