Provider Demographics
NPI:1003027145
Name:KLOOMOK, SHAUNA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHAUNA
Middle Name:
Last Name:KLOOMOK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2232 CHAPALA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3907
Mailing Address - Country:US
Mailing Address - Phone:805-682-6435
Mailing Address - Fax:805-682-6435
Practice Address - Street 1:1532 STATE ST
Practice Address - Street 2:SUITE G
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2554
Practice Address - Country:US
Practice Address - Phone:805-962-4948
Practice Address - Fax:805-962-4948
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14886103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist