Provider Demographics
NPI:1053828699
Name:KURZ, SHAWNA (LMFT)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:KURZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 SAND CREEK RD STE 202G
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-2220
Mailing Address - Country:US
Mailing Address - Phone:925-237-6880
Mailing Address - Fax:
Practice Address - Street 1:191 SAND CREEK RD STE 202G
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2220
Practice Address - Country:US
Practice Address - Phone:925-237-6880
Practice Address - Fax:925-237-6880
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT103352101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional