Provider Demographics
NPI:1023041712
Name:SHALEN, MARGARET SUSAN (MFT)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:SUSAN
Last Name:SHALEN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:PEG
Other - Middle Name:
Other - Last Name:SHALEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:1703 5TH AVE
Mailing Address - Street 2:#201
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-1826
Mailing Address - Country:US
Mailing Address - Phone:415-457-6864
Mailing Address - Fax:415-488-0327
Practice Address - Street 1:1703 5TH AVE
Practice Address - Street 2:#201
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-1826
Practice Address - Country:US
Practice Address - Phone:415-457-6864
Practice Address - Fax:415-488-0327
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32069106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFT32069OtherLICENSE