Provider Demographics
NPI:1083980759
Name:SHANLEY, ELENA (MFTI)
Entity Type:Individual
Prefix:MRS
First Name:ELENA
Middle Name:
Last Name:SHANLEY
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25852 MCBEAN PKWY
Mailing Address - Street 2:#738
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-3705
Mailing Address - Country:US
Mailing Address - Phone:661-388-0309
Mailing Address - Fax:
Practice Address - Street 1:25852 MCBEAN PKWY
Practice Address - Street 2:#738
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-3705
Practice Address - Country:US
Practice Address - Phone:661-388-0309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71125106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist