Provider Demographics
NPI:1902134661
Name:KINNEY, STACEY WHITE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:WHITE
Last Name:KINNEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 DOVE ST STE 110
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2845
Mailing Address - Country:US
Mailing Address - Phone:949-209-0010
Mailing Address - Fax:949-209-0010
Practice Address - Street 1:26441 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-8528
Practice Address - Country:US
Practice Address - Phone:949-209-0010
Practice Address - Fax:949-209-0010
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35122106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist