Healthcare Provider Details

I. General information

NPI: 1942842927
Provider Name (Legal Business Name): SHAKEELA MARIE GIPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 N GRAPE ST
ESCONDIDO CA
92025-3079
US

IV. Provider business mailing address

490 N GRAPE ST
ESCONDIDO CA
92025-3079
US

V. Phone/Fax

Practice location:
  • Phone: 760-975-9939
  • Fax:
Mailing address:
  • Phone: 760-975-9939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number22382
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: