Basic Information
| Provider Information | |||||||||
| NPI: | 1518126010 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VAN DUSEN | ||||||||
| FirstName: | ELI | ||||||||
| MiddleName: | MATTHEW | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSY D, LMFT, LAADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9465 FARNHAM ST | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921231308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585732600 | ||||||||
| FaxNumber: | 8585730982 | ||||||||
| Practice Location | |||||||||
| Address1: | 30777 RANCHO CALIFORNIA RD | ||||||||
| Address2: | |||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925913209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602781456 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2008 | ||||||||
| LastUpdateDate: | 12/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 53932 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 103TC0700X | 32823 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.