Provider Demographics
NPI:1619107729
Name:STILLPOINT FAMILY RESOURCES
Entity Type:Organization
Organization Name:STILLPOINT FAMILY RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:UNDERWOOD
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:III
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-704-1327
Mailing Address - Street 1:7444 CHAMINADE AVE.
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91304
Mailing Address - Country:US
Mailing Address - Phone:818-704-1327
Mailing Address - Fax:818-704-9117
Practice Address - Street 1:21134 COSTANSO ST
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2032
Practice Address - Country:US
Practice Address - Phone:818-704-1327
Practice Address - Fax:818-704-9117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15749101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty