Basic Information
| Provider Information | |||||||||
| NPI: | 1811024706 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FINN | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23504 LYONS AVE | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | NEWHALL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913212500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612862550 | ||||||||
| FaxNumber: | 6612862567 | ||||||||
| Practice Location | |||||||||
| Address1: | 23504 LYONS AVE. | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | NEWHALL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913212534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183471577 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 10/28/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 18309 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 18309 | 01 | CA | MARRIAGE & FAMILY THERAPIST LICENSE | OTHER |