Healthcare Provider Details

I. General information

NPI: 1396690848
Provider Name (Legal Business Name): SHELLY STOVER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12711 VENTURA BLVD STE 420
STUDIO CITY CA
91604-2456
US

IV. Provider business mailing address

12711 VENTURA BLVD STE 420
STUDIO CITY CA
91604-2456
US

V. Phone/Fax

Practice location:
  • Phone: 818-928-2981
  • Fax:
Mailing address:
  • Phone: 818-928-2981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number161966
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: