Provider Demographics
NPI:1073233664
Name:SHOWALTER, SHELLEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:
Last Name:SHOWALTER
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 1:30495 CANWOOD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4331
Mailing Address - Country:US
Mailing Address - Phone:818-707-7366
Mailing Address - Fax:
Practice Address - Street 1:30495 CANWOOD ST STE 101
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4331
Practice Address - Country:US
Practice Address - Phone:818-707-7366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19205103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical