Provider Demographics
NPI:1417143207
Name:WEUSTE, MICHEAL (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHEAL
Middle Name:
Last Name:WEUSTE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 S ESCONDIDO BLVD
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-6017
Mailing Address - Country:US
Mailing Address - Phone:760-871-2020
Mailing Address - Fax:760-489-1321
Practice Address - Street 1:1520 S ESCONDIDO BLVD
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-6017
Practice Address - Country:US
Practice Address - Phone:760-871-2020
Practice Address - Fax:760-489-1321
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0037691041C0700X
CA849451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical