Provider Demographics
NPI:1134635683
Name:SEUFERER, KHEYRSTEN
Entity Type:Individual
Prefix:MRS
First Name:KHEYRSTEN
Middle Name:
Last Name:SEUFERER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KHEYRSTEN
Other - Middle Name:
Other - Last Name:MAASCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAIDEN NAME
Mailing Address - Street 1:15105 OLDE HIGHWAY 80 SPC 11
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-2404
Mailing Address - Country:US
Mailing Address - Phone:503-949-1628
Mailing Address - Fax:
Practice Address - Street 1:3978 SORRENTO VALLEY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1436
Practice Address - Country:US
Practice Address - Phone:858-353-7723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician