Shayda Ewalt, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

107869 Issued in CA

Practice address

11838 Bernardo Plaza CT Ste 250
San Diego, CA 92128-2434

Phone

(858) 726-5957

NPI assigned

Apr 25, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective May 9, 2024 through May 9, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1556150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1689238537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11838 BERNARDO PLAZA CT STE 250",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921282434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11838 BERNARDO PLAZA CT STE 250",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921282434",
            "telephone_number": "858-726-5957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EWALT",
        "first_name": "SHAYDA",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-25",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "107869",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "107869",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Evolving Paths Therapy Marriage & Family Counseling Corporation
• Kathie Renee Evon
• Darryl K Evora, MD
• John Michael Evosevich, PH.D. LMFT
• Katherine Louise Ewalt, MS, ATC, HHP, NCTM
• James Edwin Ewen
• Eirena Elizabeth Ewert
• James Walter Ewing, PH.D.
• Janice Ewing, PH.D
• John T. Ewing, D.O.

• Marriage & Family Therapist in San Diego, CA
• Providers in San Diego, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.