Provider Demographics
NPI:1194193136
Name:SHIN, BRIAN (LMFT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:SHIN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 BOWSPRIT RD
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4529
Mailing Address - Country:US
Mailing Address - Phone:619-500-6324
Mailing Address - Fax:858-408-2402
Practice Address - Street 1:5252 BALBOA AVE STE 408
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6939
Practice Address - Country:US
Practice Address - Phone:619-500-6324
Practice Address - Fax:858-999-2014
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102882106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist