Healthcare Provider Details

I. General information

NPI: 1518126010
Provider Name (Legal Business Name): ELI MATTHEW VAN DUSEN PSY D, LMFT, LAADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7742 HERSCHEL AVE STE K
LA JOLLA CA
92037-4444
US

IV. Provider business mailing address

39583 CALADIUM DR
TEMECULA CA
92591-0363
US

V. Phone/Fax

Practice location:
  • Phone: 760-278-1453
  • Fax:
Mailing address:
  • Phone: 760-278-1453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number32823
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number53932
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: