Provider Demographics
NPI:1972325819
Name:STUTZ, RILEY
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:STUTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 W DUARTE RD UNIT C
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-5360
Mailing Address - Country:US
Mailing Address - Phone:760-969-8126
Mailing Address - Fax:
Practice Address - Street 1:11423 187TH ST STE 200
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-5657
Practice Address - Country:US
Practice Address - Phone:877-538-4133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA150963106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist