Provider Demographics
NPI:1154463271
Name:SHORTHILL, LYDIA CHARLOTTE (LMFT)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:CHARLOTTE
Last Name:SHORTHILL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4909 MURPHY CANYON RD STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4301
Mailing Address - Country:US
Mailing Address - Phone:858-268-9800
Mailing Address - Fax:
Practice Address - Street 1:4909 MURPHY CANYON RD STE 300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4301
Practice Address - Country:US
Practice Address - Phone:858-268-9800
Practice Address - Fax:858-268-9810
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42317106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4139OtherUBH NUMBER