Provider Demographics
NPI:1770075657
Name:LEMELLE, STANLEY ANTHONY (LMFT)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:ANTHONY
Last Name:LEMELLE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11780 CENTRAL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-6499
Mailing Address - Country:US
Mailing Address - Phone:909-517-2020
Mailing Address - Fax:909-517-2022
Practice Address - Street 1:11780 CENTRAL AVE STE 100
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-6499
Practice Address - Country:US
Practice Address - Phone:909-517-2020
Practice Address - Fax:909-517-2022
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT41777106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty