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General NPI Number Information
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NPI Number | 1639983208
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Entity Type | Organization
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Legal Business Name | STAGES FAMILY THERAPY AND WELLNESS CENTER, INC.
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Dates
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Enumeration Date | 02/04/2025
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 1317 DEL NORTE RD STE 200
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City | CAMARILLO
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State | CA
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Zip | 93010-8368
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Country | US
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Telephone | 805-415-2441
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Fax |
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Provider Business Mailing Address
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Address Line | 44 DUVALI DR
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City | VENTURA
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State | CA
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Zip | 93003-2151
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Country | US
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Telephone | 805-415-2441
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KERRY HOFFMAN
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Credential | MFT
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Telephone | 805-415-2441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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