=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164065033
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREETI PRESSWALA-SHAH, MARRIAGE AND FAMILY THERAPIST, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2019
-----------------------------------------------------
Last Update Date | 10/23/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6540 LUSK BLVD STE C138A
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92121-2767
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-732-0012
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6540 LUSK BLVD STE C138A
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92121-2767
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-732-0012
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOTHERAPIST
-----------------------------------------------------
Name | PREETI PRESSWALA-SHAH
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 858-939-9555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------