Provider Demographics
NPI:1194498881
Name:MAGILL, STEPHEN JOHN (LPCC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JOHN
Last Name:MAGILL
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-3902
Mailing Address - Country:US
Mailing Address - Phone:602-373-2585
Mailing Address - Fax:
Practice Address - Street 1:753 1ST ST W APT 5
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-7021
Practice Address - Country:US
Practice Address - Phone:602-373-2585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5085101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101YM0800XOtherSIMPLE PRACTICE.COM