Provider Demographics
NPI:1902440605
Name:LE MASTERS, STEPHEN ROBERT
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ROBERT
Last Name:LE MASTERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2219
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92244-2219
Mailing Address - Country:US
Mailing Address - Phone:760-353-6922
Mailing Address - Fax:760-353-8441
Practice Address - Street 1:510 W MAIN ST STE 104
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2900
Practice Address - Country:US
Practice Address - Phone:760-353-6922
Practice Address - Fax:760-353-8441
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70261101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health