Provider Demographics
NPI:1568671741
Name:STANLEY, PATRICIA ANN (MFT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:STANLEY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:TRISH
Other - Middle Name:
Other - Last Name:STANLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:5190 GOVERNOR DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-2847
Mailing Address - Country:US
Mailing Address - Phone:858-455-5557
Mailing Address - Fax:858-456-7417
Practice Address - Street 1:5190 GOVERNOR DR
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-2847
Practice Address - Country:US
Practice Address - Phone:858-455-5557
Practice Address - Fax:858-456-7417
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 8006106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist