Provider Demographics
NPI:1659482263
Name:STAIE, STEPHANIE LEE (MA, MFT)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LEE
Last Name:STAIE
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 SYCAMORE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-1208
Mailing Address - Country:US
Mailing Address - Phone:805-446-7143
Mailing Address - Fax:805-955-0569
Practice Address - Street 1:2925 SYCAMORE DR STE 105
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1208
Practice Address - Country:US
Practice Address - Phone:805-446-7143
Practice Address - Fax:805-955-0569
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30963106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist