Basic Information
| Provider Information | |||||||||
| NPI: | 1043348824 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHERIDAN | ||||||||
| FirstName: | REX | ||||||||
| MiddleName: | ADAM | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.S.MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17701 SAN PASQUAL VALLEY ROAD | ||||||||
| Address2: | |||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607414300 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 17701 SAN PASQUAL VALLEY ROAD | ||||||||
| Address2: | |||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607414300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2007 | ||||||||
| LastUpdateDate: | 03/17/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | CA MFT 44633 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.