Provider Demographics
NPI:1205407590
Name:SHAWHAN, KRISTI L
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:L
Last Name:SHAWHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7281 DUMOSA AVE.
Mailing Address - Street 2:ST. 4
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284
Mailing Address - Country:US
Mailing Address - Phone:760-853-4755
Mailing Address - Fax:
Practice Address - Street 1:7281 DUMOSA AVE.
Practice Address - Street 2:ST. 4
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284
Practice Address - Country:US
Practice Address - Phone:760-853-4755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health