Provider Demographics
NPI:1063125276
Name:JOHN STAFFORD LLC
Entity type:Organization
Organization Name:JOHN STAFFORD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:AMFT
Authorized Official - Phone:760-459-4428
Mailing Address - Street 1:45600 HIGHWAY 79 UNIT 451
Mailing Address - Street 2:
Mailing Address - City:AGUANGA
Mailing Address - State:CA
Mailing Address - Zip Code:92536-6818
Mailing Address - Country:US
Mailing Address - Phone:760-459-4428
Mailing Address - Fax:
Practice Address - Street 1:45525 HIGHWAY 79 UNIT 53
Practice Address - Street 2:
Practice Address - City:AGUANGA
Practice Address - State:CA
Practice Address - Zip Code:92536-8601
Practice Address - Country:US
Practice Address - Phone:760-459-4428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty