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General NPI Number Information
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NPI Number | 1932240876
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Entity Type | Individual
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Provider Name | STEPHANIE YAMADA MITSUUCHI PSYD
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Gender | Female
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 2525 CHERRY AVE STE 350
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City | SIGNAL HILL
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State | CA
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Zip | 90755-2061
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Country | US
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Telephone | 562-740-8477
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Fax |
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Provider Business Mailing Address
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Address Line | 21143 HAWTHORNE BLVD # 336
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City | TORRANCE
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State | CA
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Zip | 90503-4615
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Country | US
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Telephone |
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | PSB94027414
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | PSB94027414
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 35339
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License Number State | CA
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