Individual ProviderStacy IppolitoMarriage & Family TherapistBehavioral Health & Social Service ProvidersPractice Address8711 Van Horn St, La Mesa, CA 91942-3219(559) 348-3630PECOS EnrollmentBased on the most recent information from CMS, provider Stacy Ippolito does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1598436701Provider TypeIndividualFull NameIppolito, StacyTitleMrs.CredentialLMFTGenderFemaleSole ProprietorYesEnumeration Date9/27/2021Last Updated9/27/2021Contact InformationPractice LocationPractice Address8711 Van Horn St, La Mesa, CA 91942-3219Phone(559) 348-3630FaxUnlisted FaxMailing LocationMailing AddressPO Box 2502, La Mesa, CA 91943-2502Phone(559) 348-3630FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode106H00000XPrimaryDescriptionMarriage & Family TherapistBehavioral Health & Social Service ProvidersLicense115839California