Healthcare Provider Details

I. General information

NPI: 1891629010
Provider Name (Legal Business Name): HEATHER SHADLEY TOVAR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W VALLEY PKWY STE 203
ESCONDIDO CA
92025-2557
US

IV. Provider business mailing address

800 W VALLEY PKWY STE 100
ESCONDIDO CA
92025-2557
US

V. Phone/Fax

Practice location:
  • Phone: 760-796-3763
  • Fax: 760-796-3755
Mailing address:
  • Phone: 760-796-3763
  • Fax: 760-796-3755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number79526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: