Provider Demographics
NPI:1073228631
Name:BARLOCK PAGE, STOPHE
Entity Type:Individual
Prefix:
First Name:STOPHE
Middle Name:
Last Name:BARLOCK PAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 E CYPRESS AVE APT B
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-1887
Mailing Address - Country:US
Mailing Address - Phone:951-347-7015
Mailing Address - Fax:
Practice Address - Street 1:6320 CANOGA AVE STE 1500
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2517
Practice Address - Country:US
Practice Address - Phone:818-476-6268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53344106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist