Healthcare Provider Details

I. General information

NPI: 1639087547
Provider Name (Legal Business Name): ISAIAH STRAYHORN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 LA MESA BLVD STE B
LA MESA CA
91942-9572
US

IV. Provider business mailing address

8600 LA MESA BLVD STE B
LA MESA CA
91942-9572
US

V. Phone/Fax

Practice location:
  • Phone: 619-733-6414
  • Fax:
Mailing address:
  • Phone: 619-733-6414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC23180
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: