Basic Information
| Provider Information | |||||||||
| NPI: | 1891826525 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRIEND | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | MERRILL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 29142 HILLRISE DR | ||||||||
| Address2: | |||||||||
| City: | AGOURA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913011532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187083347 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11631 VICTORY BLVD | ||||||||
| Address2: | #203 | ||||||||
| City: | NORTH HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 916063572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189083855 | ||||||||
| FaxNumber: | 8187535265 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFT12199 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.