Basic Information
| Provider Information | |||||||||
| NPI: | 1366562332 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHILDHAUS | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | STUART | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.F.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3617 BERNWOOD PL | ||||||||
| Address2: | APT 102 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921301046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8587553938 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12520 HIGH BLUFF DR | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921302041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582590599 | ||||||||
| FaxNumber: | 8587947218 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 101YM0800X | MFT19749 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.