Basic Information
| Provider Information | |||||||||
| NPI: | 1477755122 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VAN TUYL | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | DAWN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 308 11TH ST | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926484506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7142347511 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10929 SOUTH ST | ||||||||
| Address2: | |||||||||
| City: | CERRITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907035340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629245526 | ||||||||
| FaxNumber: | 5629233273 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2007 | ||||||||
| LastUpdateDate: | 01/25/2013 | ||||||||
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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 | 101YM0800X | IMF53481 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | MFC49101 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.