Healthcare Provider Details

I. General information

NPI: 1235268103
Provider Name (Legal Business Name): BARBARA BEARD STEPHAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY 1 N
SAN LUIS OBISPO CA
93409-8101
US

IV. Provider business mailing address

HIGHWAY 1 N P.O. BOX 8101
SAN LUIS OBISPO CA
93409-8101
US

V. Phone/Fax

Practice location:
  • Phone: 805-547-7900
  • Fax: 805-547-7504
Mailing address:
  • Phone: 805-547-7900
  • Fax: 805-547-7504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberRPS 2006018
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: