Provider Demographics
NPI:1538680376
Name:STELZNER, MARK JORDAN
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JORDAN
Last Name:STELZNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 TELEGRAPH AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1771
Mailing Address - Country:US
Mailing Address - Phone:415-203-7352
Mailing Address - Fax:
Practice Address - Street 1:2710 TELEGRAPH AVE STE 210
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1771
Practice Address - Country:US
Practice Address - Phone:415-203-7352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-01
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13690106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist