Provider Demographics
NPI:1033309539
Name:BASKERVILLE, SHEATON MARIE
Entity Type:Individual
Prefix:MRS
First Name:SHEATON
Middle Name:MARIE
Last Name:BASKERVILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3870 CRENSHAW BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-1815
Mailing Address - Country:US
Mailing Address - Phone:323-336-0418
Mailing Address - Fax:
Practice Address - Street 1:3870 CRENSHAW BLVD STE 207
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-1815
Practice Address - Country:US
Practice Address - Phone:132-333-6041
Practice Address - Fax:323-221-3231
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87029106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist