Provider Demographics
NPI:1154463271
Name:SHORTHILL, LYDIA CHARLOTTE (MFT)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:CHARLOTTE
Last Name:SHORTHILL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270F N EL CAMINO REAL # 402
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2856
Mailing Address - Country:US
Mailing Address - Phone:858-324-4545
Mailing Address - Fax:
Practice Address - Street 1:8765 AERO DR STE 221
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1767
Practice Address - Country:US
Practice Address - Phone:858-324-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42317106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4139OtherUBH NUMBER