Healthcare Provider Details

I. General information

NPI: 1548172588
Provider Name (Legal Business Name): STACEY ANN TRUEBLOOD PAULHUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 FASHION LN STE 105
TUSTIN CA
92780-3362
US

IV. Provider business mailing address

360 E 1ST ST # 4006
TUSTIN CA
92780-3211
US

V. Phone/Fax

Practice location:
  • Phone: 714-450-7602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT158512
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: