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General NPI Number Information
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NPI Number | 1336388826
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Entity Type | Individual
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Provider Name | DESMOND GRAHAM STACEY PHD
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Gender | Male
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Dates
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Enumeration Date | 02/06/2009
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Last Update Date | 02/06/2009
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Provider Practice Location Address
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Address Line | 339 CAJON ST STE B
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City | REDLANDS
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State | CA
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Zip | 92373-5983
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Country | US
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Telephone | 909-723-7673
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Fax |
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Provider Business Mailing Address
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Address Line | 1317 W OLIVE AVE
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City | REDLANDS
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State | CA
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Zip | 92373-4927
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Country | US
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Telephone | 909-798-1814
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY18291
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License Number State | CA
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