Healthcare Provider Details

I. General information

NPI: 1649475815
Provider Name (Legal Business Name): LAURIE MICHELLE STAMPS MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 E F ST
TEHACHAPI CA
93561-1710
US

IV. Provider business mailing address

21276 WHITE PINE DR #50
TEHACHAPI CA
93561-9521
US

V. Phone/Fax

Practice location:
  • Phone: 661-301-7745
  • Fax: 661-214-3180
Mailing address:
  • Phone: 661-301-7745
  • Fax: 866-214-3180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC34491
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: