Provider Demographics
NPI:1124152913
Name:STAMPLE, MICHAEL FRANK (PHD, LMFT)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FRANK
Last Name:STAMPLE
Suffix:
Gender:M
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11939 WEDDINGTON ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-4427
Mailing Address - Country:US
Mailing Address - Phone:818-623-8785
Mailing Address - Fax:
Practice Address - Street 1:11939 WEDDINGTON ST
Practice Address - Street 2:SUITE 307
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-4427
Practice Address - Country:US
Practice Address - Phone:818-623-8785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC#34008106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist