Provider Demographics
NPI:1700117017
Name:KORFIST, STACY (LMFT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:KORFIST
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:PO BOX 2242
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90267-2242
Mailing Address - Country:US
Mailing Address - Phone:310-720-6443
Mailing Address - Fax:
Practice Address - Street 1:514 N PROSPECT AVE
Practice Address - Street 2:LL120
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3036
Practice Address - Country:US
Practice Address - Phone:310-720-6443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 37154106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist