Provider Demographics
NPI:1528332665
Name:STICKLER, STEPHEN (EDS, PPS, LEP)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:STICKLER
Suffix:
Gender:M
Credentials:EDS, PPS, LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9401 PAINTER AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-2729
Mailing Address - Country:US
Mailing Address - Phone:562-698-8121
Mailing Address - Fax:
Practice Address - Street 1:7291 GARDEN GROVE BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-4211
Practice Address - Country:US
Practice Address - Phone:714-901-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP # 3087103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist