Provider Demographics
NPI:1457799207
Name:STELTER, MARY CORDELIA
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CORDELIA
Last Name:STELTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14526 GREVILLEA AVE
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-1451
Mailing Address - Country:US
Mailing Address - Phone:310-973-4514
Mailing Address - Fax:
Practice Address - Street 1:14526 GREVILLEA AVE
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1451
Practice Address - Country:US
Practice Address - Phone:310-973-4514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
CA94026502103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No374J00000XNursing Service Related ProvidersDoula