MEDICARE: ERIN M STALEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	18290	CA

General Provider Information

NPI Number	:	1427992742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN M STALEY

Provider Business Mailing Address
First Line	:	2123 S ORANGE DR APT 1
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-2200
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2123 S ORANGE DR APT 1
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-2200
Country	:	US
Telephone Number	:	805-501-2687
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2026
Last Update Date	:	04/16/2026

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Directions to “ ERIN M STALEY ” Practice Location

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