Healthcare Provider Details

I. General information

NPI: 1427245323
Provider Name (Legal Business Name): STACEY LEE MERRELL LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7365 CARNELIAN ST STE 240
RANCHO CUCAMONGA CA
91730-1136
US

IV. Provider business mailing address

7365 CARNELIAN ST STE 240
RANCHO CUCAMONGA CA
91730-1136
US

V. Phone/Fax

Practice location:
  • Phone: 909-281-1557
  • Fax: 877-850-5695
Mailing address:
  • Phone: 909-281-1557
  • Fax: 877-850-5695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 46624
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: