Provider Demographics
NPI:1144619131
Name:SHAPIN, JACLYN FALLON (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:FALLON
Last Name:SHAPIN
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:SHAPIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:56 COTTAGE LN
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-4201
Mailing Address - Country:US
Mailing Address - Phone:949-295-1041
Mailing Address - Fax:
Practice Address - Street 1:766 COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-1702
Practice Address - Country:US
Practice Address - Phone:323-255-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84626106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist