Provider Demographics
NPI:1487483152
Name:STANSELL, ELISE MARIE
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:MARIE
Last Name:STANSELL
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 1:5496 HACKNEY LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94803-3829
Mailing Address - Country:US
Mailing Address - Phone:916-693-9487
Mailing Address - Fax:
Practice Address - Street 1:5496 HACKNEY LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94803-3829
Practice Address - Country:US
Practice Address - Phone:916-693-9487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician