Provider Demographics
NPI:1942341219
Name:BROSAMLE, STANTON LAYNE (MS MFT)
Entity Type:Individual
Prefix:MR
First Name:STANTON
Middle Name:LAYNE
Last Name:BROSAMLE
Suffix:
Gender:M
Credentials:MS MFT
Other - Prefix:
Other - First Name:STANTON
Other - Middle Name:LAYNE
Other - Last Name:KATZ BROSAMLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2150 TAHQUITZ CANYON WAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262
Mailing Address - Country:US
Mailing Address - Phone:760-323-8016
Mailing Address - Fax:760-322-7652
Practice Address - Street 1:2150 TAHQUITZ CANYON WAY
Practice Address - Street 2:SUITE 3
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262
Practice Address - Country:US
Practice Address - Phone:760-323-8016
Practice Address - Fax:760-322-7652
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC18948106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist