Provider Demographics
NPI:1669962601
Name:SHRADER-HANES, SUE ELLEN (LMFT)
Entity type:Individual
Prefix:MS
First Name:SUE
Middle Name:ELLEN
Last Name:SHRADER-HANES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:SUE
Other - Middle Name:E
Other - Last Name:SHRADER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:6741 SPRINGFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-1531
Mailing Address - Country:US
Mailing Address - Phone:619-262-7669
Mailing Address - Fax:
Practice Address - Street 1:10640 SCRIPPS RANCH BLVD STE 2002ND
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1095
Practice Address - Country:US
Practice Address - Phone:858-217-5770
Practice Address - Fax:619-924-9931
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30118106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist