Provider Demographics
NPI:1295806065
Name:EISCHEN-LEE, STEPHANIE ELLEN (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ELLEN
Last Name:EISCHEN-LEE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 E AVE
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-2545
Mailing Address - Country:US
Mailing Address - Phone:619-435-0603
Mailing Address - Fax:
Practice Address - Street 1:7060 CLAIREMONT MESA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1003
Practice Address - Country:US
Practice Address - Phone:858-573-5447
Practice Address - Fax:858-573-5630
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19145103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical