Provider Demographics
NPI:1457685141
Name:PADILLA, SHALISS (BS, MA, MFT)
Entity Type:Individual
Prefix:MRS
First Name:SHALISS
Middle Name:
Last Name:PADILLA
Suffix:
Gender:F
Credentials:BS, MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N MAIN ST
Mailing Address - Street 2:STE. 500
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-3640
Mailing Address - Country:US
Mailing Address - Phone:714-834-7840
Mailing Address - Fax:
Practice Address - Street 1:440 S MELROSE DR STE 200
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6666
Practice Address - Country:US
Practice Address - Phone:833-444-6463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health