Healthcare Provider Details

I. General information

NPI: 1093285009
Provider Name (Legal Business Name): DAKOTAH STORAY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2018
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1695 S SAN JACINTO AVE STE ABCDF
SAN JACINTO CA
92583-5103
US

IV. Provider business mailing address

340 E 1ST ST # 6
TUSTIN CA
92781
US

V. Phone/Fax

Practice location:
  • Phone: 951-330-3100
  • Fax: 951-350-1050
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number138172
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: