Provider Demographics
NPI:1376925362
Name:STOLPER, KEVIN (LMFT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:STOLPER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 RAVENSBURY ST
Mailing Address - Street 2:
Mailing Address - City:LAKE SHERWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91361-5163
Mailing Address - Country:US
Mailing Address - Phone:310-720-4822
Mailing Address - Fax:
Practice Address - Street 1:169 PIER AVE STE 2
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405
Practice Address - Country:US
Practice Address - Phone:310-720-4822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-25
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87384106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist