Basic Information
| Provider Information | |||||||||
| NPI: | 1902936693 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GALVIN | ||||||||
| FirstName: | STACEY | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10061 TALBERT AVE. #200 | ||||||||
| Address2: | |||||||||
| City: | FOUNTAIN VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149653622 | ||||||||
| FaxNumber: | 9099806003 | ||||||||
| Practice Location | |||||||||
| Address1: | 10061 TALBERT AVE. #200 | ||||||||
| Address2: | |||||||||
| City: | FOUNTAIN VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149653622 | ||||||||
| FaxNumber: | 9099806003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 11/28/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | MFC40424 | CA | Y | Behavioral Health & Social Service Providers | Counselor | 106H00000X | MFC40424 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.