Healthcare Provider Details

I. General information

NPI: 1518733344
Provider Name (Legal Business Name): STEPHANIE ELISE OCHS APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2023
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 CONGRESS ST STE 1D
SAN DIEGO CA
92110-2766
US

IV. Provider business mailing address

2725 CONGRESS ST STE 1D
SAN DIEGO CA
92110-2766
US

V. Phone/Fax

Practice location:
  • Phone: 619-288-6866
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10950
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: