Provider Demographics
NPI:1780332924
Name:FLOOD, STEPHANIE (MFT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:FLOOD
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2183 LA MIEL WAY
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-2663
Mailing Address - Country:US
Mailing Address - Phone:508-904-0846
Mailing Address - Fax:
Practice Address - Street 1:2183 LA MIEL WAY
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2663
Practice Address - Country:US
Practice Address - Phone:508-904-0846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52873101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty