Provider Demographics
NPI:1346546157
Name:PASIMIO, STACIE A (LMFT)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:A
Last Name:PASIMIO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:STACIE
Other - Middle Name:A
Other - Last Name:SEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3200 E GUASTI RD STE 178B
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-8660
Mailing Address - Country:US
Mailing Address - Phone:909-600-8134
Mailing Address - Fax:
Practice Address - Street 1:3200 E GUASTI RD STE 178B
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-8660
Practice Address - Country:US
Practice Address - Phone:909-255-0443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79267101YM0800X, 106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty