Provider Demographics
NPI:1134459373
Name:SHUGART, JILL SELIN (MFT)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:SELIN
Last Name:SHUGART
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 TULARE AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-2112
Mailing Address - Country:US
Mailing Address - Phone:510-528-0309
Mailing Address - Fax:510-526-3739
Practice Address - Street 1:39 QUAIL CT
Practice Address - Street 2:SUITE 205
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5566
Practice Address - Country:US
Practice Address - Phone:510-528-0309
Practice Address - Fax:510-526-3739
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT32528106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist