Provider Demographics
NPI:1124363759
Name:ALEXANDER, SHAWNEE LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:SHAWNEE
Middle Name:LEE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 FOREST GLEN RD
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-6942
Mailing Address - Country:US
Mailing Address - Phone:714-777-6891
Mailing Address - Fax:
Practice Address - Street 1:17542 17TH ST STE 300
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-1960
Practice Address - Country:US
Practice Address - Phone:714-734-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-08
Last Update Date:2012-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA290071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical