Provider Demographics
NPI:1154669604
Name:SHANNON DOBBS PSY.D CORP
Entity Type:Organization
Organization Name:SHANNON DOBBS PSY.D CORP
Other - Org Name:SHANNON DOBBS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-428-2431
Mailing Address - Street 1:2060D E AVENIDA DE LOS ARBOLES # 239
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-1376
Mailing Address - Country:US
Mailing Address - Phone:310-428-2431
Mailing Address - Fax:800-713-1290
Practice Address - Street 1:28310 ROADSIDE DR STE 203
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4958
Practice Address - Country:US
Practice Address - Phone:310-428-2431
Practice Address - Fax:800-713-1290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty