=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114193596
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANISE RENE STYS LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2008
-----------------------------------------------------
Last Update Date | 05/05/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23181 VERDUGO DR SUITE 104-A
-----------------------------------------------------
City | LAGUNA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92653-1357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-249-4483
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 235
-----------------------------------------------------
City | EAST IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92650-0235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-249-4483
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFC38240
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------