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General NPI Number Information
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NPI Number | 1578135935
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Entity Type | Organization
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Legal Business Name | TRAILS THERAPY, A PSYCHOLOGICAL CORPORATION
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Dates
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Enumeration Date | 07/15/2021
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Last Update Date | 05/11/2022
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Provider Practice Location Address
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Address Line | 3344 4TH AVE STE 100
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City | SAN DIEGO
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State | CA
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Zip | 92103-5704
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Country | US
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Telephone | 619-550-7447
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Fax | 619-567-2311
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Provider Business Mailing Address
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Address Line | 6224 OAKRIDGE RD
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City | SAN DIEGO
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State | CA
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Zip | 92120-2148
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Country | US
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Telephone | 619-990-7150
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Fax | 619-567-2311
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Authorized Official
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Title or Position | CEO PSYCHOLOGIST
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Name | DR. BRITTANY CHIDLEY
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Credential | PSYD
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Telephone | 619-990-7150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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