Provider Demographics
NPI:1245877562
Name:MAGANA, STEPHANIE RAE (MS, LMFT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RAE
Last Name:MAGANA
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4255 CAMPUS DR STE A245
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-8630
Mailing Address - Country:US
Mailing Address - Phone:951-790-2840
Mailing Address - Fax:
Practice Address - Street 1:4255 CAMPUS DR STE A245
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-8630
Practice Address - Country:US
Practice Address - Phone:951-790-2840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA116470106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist