Healthcare Provider Details

I. General information

NPI: 1982006797
Provider Name (Legal Business Name): STEPHANIE APRIL OTTERSTETTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE APRIL LLOYD

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 TESCONI CIR STE B
SANTA ROSA CA
95401-4691
US

IV. Provider business mailing address

480 TESCONI CIR STE B
SANTA ROSA CA
95401-4691
US

V. Phone/Fax

Practice location:
  • Phone: 707-806-2443
  • Fax:
Mailing address:
  • Phone: 707-806-2443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number132659
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT164197
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: