Provider Demographics
NPI:1063560365
Name:LANDER, STEPHEN KING (LMFT)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:KING
Last Name:LANDER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:796 N SEVILLE CIR
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-6242
Mailing Address - Country:US
Mailing Address - Phone:612-205-4576
Mailing Address - Fax:
Practice Address - Street 1:71687 HIGHWAY 111 STE 205
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4515
Practice Address - Country:US
Practice Address - Phone:612-205-4576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLMFT #834101YM0800X
MNMA LP #3316101YM0800X
CA20572101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
41-1836968OtherFED TAX ID