Healthcare Provider Details

I. General information

NPI: 1407397995
Provider Name (Legal Business Name): STEPHANIE ERIN MEJIA L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE ERIN PATTON

II. Dates (important events)

Enumeration Date: 03/16/2017
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 E PALMDALE BLVD
PALMDALE CA
93550-4957
US

IV. Provider business mailing address

2323 E PALMDALE BLVD
PALMDALE CA
93550-4957
US

V. Phone/Fax

Practice location:
  • Phone: 616-223-3800
  • Fax: 661-537-2938
Mailing address:
  • Phone: 213-332-1096
  • Fax: 661-537-2938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number75569
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW75569
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number110119
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: