Provider Demographics
NPI:1093306847
Name:PICKARD, SHANYA (AMFT)
Entity Type:Individual
Prefix:
First Name:SHANYA
Middle Name:
Last Name:PICKARD
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-3496
Mailing Address - Country:US
Mailing Address - Phone:530-350-9290
Mailing Address - Fax:
Practice Address - Street 1:3960 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-3496
Practice Address - Country:US
Practice Address - Phone:530-350-9290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA123508106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist