Provider Demographics
NPI:1528021243
Name:IHLER, FREDRICK W (LCSW)
Entity Type:Individual
Prefix:MR
First Name:FREDRICK
Middle Name:W
Last Name:IHLER
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 1:1174 E MAIN ST SPC 143
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-7124
Mailing Address - Country:US
Mailing Address - Phone:619-201-8462
Mailing Address - Fax:619-201-8463
Practice Address - Street 1:1174 E MAIN ST SPC 143
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-7124
Practice Address - Country:US
Practice Address - Phone:619-201-8462
Practice Address - Fax:619-201-8463
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 14795101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS147950OtherBLUE SHIELD OF CALIFORNIA
CACSW147950Medicaid
CASW14795BMedicare ID - Type Unspecified