Healthcare Provider Details

I. General information

NPI: 1619736659
Provider Name (Legal Business Name): TODD P STOCKWELL AMFT161643
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2024
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2085 RUSTIN AVE
RIVERSIDE CA
92507-2498
US

IV. Provider business mailing address

40891 SONATA CT
PALM DESERT CA
92260-0349
US

V. Phone/Fax

Practice location:
  • Phone: 760-863-8258
  • Fax:
Mailing address:
  • Phone: 762-835-8540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT161643
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: