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1487835203

NPI Code Detail

MEDICARE: DR. MICHAEL LEE STANFILL PH.D.

MEDICARE: DR. MICHAEL LEE STANFILL PH.D.

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	103T00000X	Psychologist	PY60273012	WA
2	103TA0400X	Addiction (Substance Use Disorder) Psychologist	PY60273012	WA
3	103TC0700X	Clinical Psychologist	PY60273012	WA
4	103TC2200X	Clinical Child & Adolescent Psychologist	PY60273012	WA
5	103TB0200X	Cognitive & Behavioral Psychologist	PY60273012	WA
6	103TF0200X	Forensic Psychologist	PY60273012	WA
7	103TP2701X	Group Psychotherapy Psychologist	PY60273012	WA
8	103TH0100X	Health Service Psychologist	PY60273012	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PY60273012	OTHER	WA	PSYCHOLOGY LICENSE

General Provider Information

NPI Number	:	1487835203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL LEE STANFILL PH.D.

Provider Business Mailing Address
First Line	:	4461 PARK BLVD
Second Line	:	#4
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-4098
Country	:	US
Telephone Number	:	480-206-8425
Fax Number	:

Provider Business Practice Location Address
First Line	:	11878 AVENUE OF INDUSTRY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-3423
Country	:	US
Telephone Number	:	858-675-4200
Fax Number	:

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

Provider Enumeration Date	:	11/20/2007
Last Update Date	:	07/25/2012

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Directions to “ DR. MICHAEL LEE STANFILL PH.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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