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Organization
SHANNON LERACH, PH.D., INC., A PSYCHOLOGICAL CORPORATION
Active
Organization
SHANNON LERACH, PH.D., INC., A PSYCHOLOGICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANNON LERACH PH.D. (OWNER)
(619) 817-5320
Entity
Organization
Contact information
Practice address
243 N HIGHWAY 101 STE 16, SOLANA BEACH, CA 92075-1167
(619) 817-5320
Mailing address
243 N HIGHWAY 101 STE 16, SOLANA BEACH, CA 92075-1167
(619) 817-5320
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396983748
—
CA
05
—
1902947005
—
CA
Enumeration date
01/16/2023
Last updated
01/16/2023
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