1306662697 NPI number — DR. SHANNEL HELEN KASSIS ELHELOU PSY.D.

Table of content: DR. SHANNEL HELEN KASSIS ELHELOU PSY.D. (NPI 1306662697)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306662697 NPI number — DR. SHANNEL HELEN KASSIS ELHELOU PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELHELOU
Provider First Name:
SHANNEL
Provider Middle Name:
HELEN KASSIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306662697
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12791 LONE TRAIL CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOORPARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93021-1168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-800-0514
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 20TH ST STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA MONICA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90404-2050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-582-7641
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/02/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X , with the licence number:  35236 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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