Provider Demographics
NPI:1528519659
Name:STEPPING FORWARD GROUP LLC
Entity type:Organization
Organization Name:STEPPING FORWARD GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD , MFT
Authorized Official - Phone:949-333-1209
Mailing Address - Street 1:15375 BARRANCA PKWY
Mailing Address - Street 2:SUITE B-101
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2217
Mailing Address - Country:US
Mailing Address - Phone:949-333-1209
Mailing Address - Fax:949-333-1208
Practice Address - Street 1:15375 BARRANCA PKWY
Practice Address - Street 2:SUITE B-101
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2217
Practice Address - Country:US
Practice Address - Phone:949-333-1209
Practice Address - Fax:949-333-1208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health