=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952948473
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GRACE STIRLING MA LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2019
-----------------------------------------------------
Last Update Date | 06/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 STORKE RD STE 7
-----------------------------------------------------
City | GOLETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93117-2969
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-570-7678
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7025 MARYMOUNT WAY
-----------------------------------------------------
City | GOLETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93117-2985
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 138703
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------