Provider Demographics
NPI:1063250702
Name:STITT, SEAN D (AMFT)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:D
Last Name:STITT
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 N MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4172
Mailing Address - Country:US
Mailing Address - Phone:800-906-0862
Mailing Address - Fax:
Practice Address - Street 1:870 N MOUNTAIN AVE STE 206
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4173
Practice Address - Country:US
Practice Address - Phone:800-906-0862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT146840106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist