Provider Demographics
NPI:1770651341
Name:MITCHELL, STACY MAUREEN (LMFT)
Entity Type:Individual
Prefix:MISS
First Name:STACY
Middle Name:MAUREEN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:772 LOMA AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-5216
Mailing Address - Country:US
Mailing Address - Phone:949-793-3459
Mailing Address - Fax:
Practice Address - Street 1:4510 E PACIFIC COAST HWY STE 210
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-6928
Practice Address - Country:US
Practice Address - Phone:562-476-6955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT44748106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALMFT44748OtherCALIFORNIA BOARD OF BEHAVIORAL SCIENCES