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General NPI Number Information
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NPI Number | 1982451142
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Entity Type | Individual
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Provider Name | STACEY LIND WIDGER
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Gender | Female
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Dates
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Enumeration Date | 05/03/2024
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 13323 W WASHINGTON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90066-5170
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Country | US
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Telephone | 323-301-3407
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Fax |
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Provider Business Mailing Address
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Address Line | 13101 W WASHINGTON BLVD STE 134
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City | LOS ANGELES
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State | CA
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Zip | 90066-8122
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Country | US
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Telephone | 310-306-8000
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 156445
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License Number State | CA
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