Provider Demographics
NPI:1679874960
Name:KLINDT, STEPHANIE E (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:E
Last Name:KLINDT
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 1:25709 VAN LEUVEN ST
Mailing Address - Street 2:APT 8
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2583
Mailing Address - Country:US
Mailing Address - Phone:831-750-0162
Mailing Address - Fax:
Practice Address - Street 1:1647 E HOLT BLVD
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-2107
Practice Address - Country:US
Practice Address - Phone:831-750-0162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71761106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist