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General NPI Number Information
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NPI Number | 1528519659
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Entity Type | Organization
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Legal Business Name | STEPPING FORWARD GROUP LLC
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Dates
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Enumeration Date | 10/24/2016
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Last Update Date | 10/24/2016
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Provider Practice Location Address
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Address Line | 15375 BARRANCA PKWY SUITE B-101
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City | IRVINE
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State | CA
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Zip | 92618-2217
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Country | US
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Telephone | 949-333-1209
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Fax | 949-333-1208
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Provider Business Mailing Address
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Address Line | 15375 BARRANCA PKWY SUITE B-101
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City | IRVINE
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State | CA
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Zip | 92618-2217
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Country | US
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Telephone | 949-333-1209
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Fax | 949-333-1208
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | DR. MITCH SHAFFER
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Credential | PH.D , MFT
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Telephone | 949-333-1209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State | CA
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