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General NPI Number Information
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NPI Number | 1194498881
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Entity Type | Individual
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Provider Name | STEPHEN JOHN MAGILL LPCC
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Gender | Male
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Dates
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Enumeration Date | 07/28/2021
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Last Update Date | 07/28/2021
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Provider Practice Location Address
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Address Line | 753 1ST ST W APT 5
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City | SONOMA
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State | CA
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Zip | 95476-7021
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Country | US
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Telephone | 602-373-2585
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Fax |
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Provider Business Mailing Address
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Address Line | 718 SPRING ST
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City | SANTA ROSA
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State | CA
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Zip | 95404-3902
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Country | US
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Telephone | 602-373-2585
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5085
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License Number State | CA
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