Provider Demographics
NPI:1306123807
Name:STAHL, JOHN STEVEN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:STEVEN
Last Name:STAHL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 DAWSON AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-4529
Mailing Address - Country:US
Mailing Address - Phone:562-305-1493
Mailing Address - Fax:
Practice Address - Street 1:1601 E 10TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-5035
Practice Address - Country:US
Practice Address - Phone:562-305-1493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)