Healthcare Provider Details

I. General information

NPI: 1538964333
Provider Name (Legal Business Name): STEPHANIE ANNE MOHTASHEMI AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 02/17/2025
Certification Date: 02/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 N ALTA DENA ST
MOUNTAIN HOUSE CA
95391-1148
US

IV. Provider business mailing address

82 N ALTA DENA ST
MOUNTAIN HOUSE CA
95391-1148
US

V. Phone/Fax

Practice location:
  • Phone: 925-639-5306
  • Fax:
Mailing address:
  • Phone: 925-639-5306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number151810
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: