=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306927959
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURIE MICHELLE SHEAR MFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2006
-----------------------------------------------------
Last Update Date | 06/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 720 E SAN YSIDRO BLVD RM 116
-----------------------------------------------------
City | SAN YSIDRO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92173-3101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-695-1619
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6394 RANCHO MISSION RD UNIT 111
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92108-1988
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFC47195
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------