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General NPI Number Information
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NPI Number | 1619107729
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Entity Type | Organization
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Legal Business Name | STILLPOINT FAMILY RESOURCES
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Dates
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Enumeration Date | 07/23/2009
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Last Update Date | 07/23/2009
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Provider Practice Location Address
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Address Line | 21134 COSTANSO ST
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City | WOODLAND HILLS
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State | CA
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Zip | 91364-2032
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Country | US
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Telephone | 818-704-1327
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Fax | 818-704-9117
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Provider Business Mailing Address
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Address Line | 7444 CHAMINADE AVE.
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City | WEST HILLS
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State | CA
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Zip | 91304
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Country | US
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Telephone | 818-704-1327
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Fax | 818-704-9117
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/PSYCHOLOGIST
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Name | DR. ROSS UNDERWOOD PORTER III
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Credential | PH.D.
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Telephone | 818-704-1327
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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 | PSY15749
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License Number State | CA
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