Provider Demographics
NPI:1366562332
Name:SCHILDHAUS, JASON STUART (MFT)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:STUART
Last Name:SCHILDHAUS
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 BERNWOOD PL
Mailing Address - Street 2:APT 102
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-1046
Mailing Address - Country:US
Mailing Address - Phone:858-755-3938
Mailing Address - Fax:
Practice Address - Street 1:12520 HIGH BLUFF DR
Practice Address - Street 2:SUITE 120
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2041
Practice Address - Country:US
Practice Address - Phone:858-259-0599
Practice Address - Fax:858-794-7218
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT19749101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health