Provider Demographics
NPI:1043892607
Name:SHAFEE, GHAZALEH (MSP)
Entity Type:Individual
Prefix:MISS
First Name:GHAZALEH
Middle Name:
Last Name:SHAFEE
Suffix:
Gender:F
Credentials:MSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33630 PECAN AVE
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-6428
Mailing Address - Country:US
Mailing Address - Phone:818-383-4655
Mailing Address - Fax:
Practice Address - Street 1:33630 PECAN AVE
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-6428
Practice Address - Country:US
Practice Address - Phone:818-383-4655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional