1992948954 NPI number — MR. STEPHEN SAFFORD WOLFSON M.A., LMFT

Table of content: MR. STEPHEN SAFFORD WOLFSON M.A., LMFT (NPI 1992948954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992948954 NPI number — MR. STEPHEN SAFFORD WOLFSON M.A., LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLFSON
Provider First Name:
STEPHEN
Provider Middle Name:
SAFFORD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.A., LMFT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992948954
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
777 E TAHQUITZ CANYON WAY
Provider Second Line Business Mailing Address:
SUITE 200-180
Provider Business Mailing Address City Name:
PALM SPRINGS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92262-6784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-584-1146
Provider Business Mailing Address Fax Number:
310-584-1146

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23852 PACIFIC COAST HWY # 268
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MALIBU
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90265-4879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-584-1146
Provider Business Practice Location Address Fax Number:
310-584-1146
Provider Enumeration Date:
04/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  45368 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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