Provider Demographics
NPI:1639206352
Name:RIOS, STEPHANIE ANN (MFT INTERN)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ANN
Last Name:RIOS
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1927
Mailing Address - Street 2:P.O. BOX 1927
Mailing Address - City:BIG BEAR LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92315-1927
Mailing Address - Country:US
Mailing Address - Phone:909-866-5721
Mailing Address - Fax:909-866-3228
Practice Address - Street 1:41945 BIG BEAR BLVD.
Practice Address - Street 2:SUITE 200
Practice Address - City:BIG BEAR LAKE
Practice Address - State:CA
Practice Address - Zip Code:92315
Practice Address - Country:US
Practice Address - Phone:909-866-5712
Practice Address - Fax:909-866-3228
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 42728106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5034OtherMEDICAL SIMON NUMBER
CAIMF 42728OtherMFT INTERN NUMBER