Basic Information
| Provider Information | |||||||||
| NPI: | 1073549309 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STUELAND | ||||||||
| FirstName: | MARNI | ||||||||
| MiddleName: | LISA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15525 POMERADO RD | ||||||||
| Address2: | SUITE A-7 | ||||||||
| City: | POWAY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920642435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582791223 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7875 HIGHLAND VILLAGE PL STE B102 #189 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921299212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584445488 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 10/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC38710 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.