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General NPI Number Information
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NPI Number | 1952874042
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Entity Type | Organization
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Legal Business Name | STEPHENS THERAPY ASSOCIATES, INC.
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Dates
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Enumeration Date | 01/10/2019
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Last Update Date | 01/10/2019
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Provider Practice Location Address
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Address Line | 4025 CAMINO DEL RIO S STE 300
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City | SAN DIEGO
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State | CA
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Zip | 92108-4108
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Country | US
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Telephone | 619-542-7720
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Fax | 888-337-3402
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Provider Business Mailing Address
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Address Line | 4025 CAMINO DEL RIO S STE 300
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City | SAN DIEGO
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State | CA
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Zip | 92108-4108
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Country | US
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Telephone | 619-542-7720
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Fax | 888-337-3402
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Authorized Official
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Title or Position | DIRECTOR
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Name | BRENDA STEPHENS
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Credential | LPCC
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Telephone | 619-542-7720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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