Provider Demographics
NPI:1821435561
Name:SHRINKLE, SUSAN (MS, MFT)
Entity Type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:
Last Name:SHRINKLE
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1856 WILSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1126
Mailing Address - Country:US
Mailing Address - Phone:760-613-7073
Mailing Address - Fax:844-594-2433
Practice Address - Street 1:171 SAXONY RD STE 104
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-6776
Practice Address - Country:US
Practice Address - Phone:760-613-7073
Practice Address - Fax:844-594-2433
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86786106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist