1356771430 NPI number — SHAWN LARE BRINKLEY LMFT

Table of content: SUSAN PARADISE MFT (NPI 1215050596)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356771430 NPI number — SHAWN LARE BRINKLEY LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRINKLEY
Provider First Name:
SHAWN
Provider Middle Name:
LARE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT
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:
1356771430
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12334 CARL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PACOIMA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91331-1467
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-359-6921
Provider Business Mailing Address Fax Number:
747-225-0696

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18719 CALVERT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TARZANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-798-3201
Provider Business Practice Location Address Fax Number:
747-225-0696
Provider Enumeration Date:
11/26/2013

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: 106H00000X , with the licence number:  102664 , 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)

  • Identifier: 102664 . This is a "LMFT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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