Healthcare Provider Details

I. General information

NPI: 1871621102
Provider Name (Legal Business Name): STEPHANIE PRINCE LING M.S., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S DE LACEY AVE SUITE 110
PASADENA CA
91105-2048
US

IV. Provider business mailing address

P.O. BOX 11531
BURBANK CA
91510
US

V. Phone/Fax

Practice location:
  • Phone: 626-395-7100
  • Fax: 626-395-7270
Mailing address:
  • Phone: 818-220-6529
  • Fax: 626-395-7270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number49118
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberMFTI 43621
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: