Provider Demographics
NPI:1184874802
Name:STEPHENS, ANN DOUD (MA, MFT)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:DOUD
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S VICTORIA AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93009-0001
Mailing Address - Country:US
Mailing Address - Phone:805-650-4069
Mailing Address - Fax:805-654-2240
Practice Address - Street 1:333 N LANTANA ST
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-9010
Practice Address - Country:US
Practice Address - Phone:805-650-4069
Practice Address - Fax:805-654-2240
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC45851106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist