Provider Demographics
NPI:1235450156
Name:STIEHL, CHRISTINE (MA, BCBA, LBA)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:STIEHL
Suffix:
Gender:X
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:
Other - Last Name:STIEHL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3105 BONNIE LN
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-3647
Mailing Address - Country:US
Mailing Address - Phone:858-735-3843
Mailing Address - Fax:785-371-1263
Practice Address - Street 1:3105 BONNIE LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-3647
Practice Address - Country:US
Practice Address - Phone:858-735-3843
Practice Address - Fax:785-371-1263
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-18-31472103K00000X
CO1-18-31472103K00000X
KS264103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201288760AMedicaid