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General NPI Number Information
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NPI Number | 1518126010
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Entity Type | Individual
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Provider Name | ELI MATTHEW VAN DUSEN PSY D, LMFT, LAADC
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Gender | Male
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 12/09/2021
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Provider Practice Location Address
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Address Line | 30777 RANCHO CALIFORNIA RD
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City | TEMECULA
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State | CA
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Zip | 92591-3209
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Country | US
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Telephone | 760-278-1456
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Fax |
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Provider Business Mailing Address
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Address Line | 9465 FARNHAM ST
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City | SAN DIEGO
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State | CA
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Zip | 92123-1308
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Country | US
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Telephone | 858-573-2600
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Fax | 858-573-0982
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 53932
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 32823
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License Number State | CA
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