Basic Information
| Provider Information | |||||||||
| NPI: | 1396075800 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUGHES | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA, IMFT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HESSLER | ||||||||
| OtherFirstName: | STEPHANIE | ||||||||
| OtherMiddleName: | ANN | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MA, IMFT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1124 BAY BLVD | ||||||||
| Address2: | STE. D | ||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919117155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196562491 | ||||||||
| FaxNumber: | 6194208722 | ||||||||
| Practice Location | |||||||||
| Address1: | 1124 BAY BLVD | ||||||||
| Address2: | STE. D | ||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919117155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196562491 | ||||||||
| FaxNumber: | 6194208722 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2010 | ||||||||
| LastUpdateDate: | 01/05/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF 62278 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.