Provider Demographics
NPI:1134697642
Name:SARKISIAN, SHELLY (AMFT)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:SARKISIAN
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 1:1171 HOMESTEAD RD STE 220
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-5485
Mailing Address - Country:US
Mailing Address - Phone:800-660-9443
Mailing Address - Fax:833-256-4225
Practice Address - Street 1:1171 HOMESTEAD RD STE 220
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-5485
Practice Address - Country:US
Practice Address - Phone:833-256-4225
Practice Address - Fax:833-256-4225
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10336106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist