Provider Demographics
NPI:1114178480
Name:STANLEY, STEPHEN PAUL (MS)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:PAUL
Last Name:STANLEY
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16940 HIGHWAY 14
Mailing Address - Street 2:SUITE F
Mailing Address - City:MOJAVE
Mailing Address - State:CA
Mailing Address - Zip Code:93501-1238
Mailing Address - Country:US
Mailing Address - Phone:661-824-5020
Mailing Address - Fax:661-824-5026
Practice Address - Street 1:16940 HIGHWAY 14
Practice Address - Street 2:SUITE F
Practice Address - City:MOJAVE
Practice Address - State:CA
Practice Address - Zip Code:93501-1238
Practice Address - Country:US
Practice Address - Phone:661-824-5020
Practice Address - Fax:661-824-5026
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 55853106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist