Provider Demographics
NPI:1134755804
Name:STOCKTON FAMILY THERAPY, PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:STOCKTON FAMILY THERAPY, PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARLAND
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:916-541-0313
Mailing Address - Street 1:20 N SUTTER ST STE 400
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-2911
Mailing Address - Country:US
Mailing Address - Phone:209-513-1908
Mailing Address - Fax:
Practice Address - Street 1:20 N SUTTER ST STE 400
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2911
Practice Address - Country:US
Practice Address - Phone:209-513-1908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health