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General NPI Number Information
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NPI Number | 1205082831
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Entity Type | Organization
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Legal Business Name | SUE E. SHRADER,MFT
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Dates
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Enumeration Date | 08/14/2008
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Last Update Date | 08/20/2008
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Provider Practice Location Address
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Address Line | 4445 EASTGATE MALL
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City | SAN DIEGO
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State | CA
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Zip | 92121-1979
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Country | US
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Telephone | 858-337-5291
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Fax | 619-269-5091
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Provider Business Mailing Address
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Address Line | 4445 EASTGATE MALL
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City | SAN DIEGO
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State | CA
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Zip | 92121-1979
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Country | US
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Telephone | 858-337-5291
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Fax | 619-269-5091
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Authorized Official
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Title or Position | SUE E. SHRADER, MFT
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Name | MS. SUE E HANES
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Credential | MARRIAGE FAMILY THER
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Telephone | 858-337-5291
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MFC30118
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License Number State | CA
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