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General NPI Number Information
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NPI Number | 1700412129
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Entity Type | Organization
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Legal Business Name | SHAUDI ADEL, A LICENSED CLINICAL SOCIAL WORKER, INC.
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Dates
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Enumeration Date | 03/17/2020
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Last Update Date | 12/12/2020
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Provider Practice Location Address
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Address Line | 1968 S COAST HWY # 5025
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-3681
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Country | US
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Telephone | 858-215-3885
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Fax |
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Provider Business Mailing Address
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Address Line | 1968 S COAST HWY # 5025
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-3681
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Country | US
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Telephone | 858-215-3885
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | BRIAN CLINE
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Credential |
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Telephone | 858-215-3885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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