Provider Demographics
NPI:1225351513
Name:SHULLEN, JENNIFER (AA, BA, AOD CERT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:SHULLEN
Suffix:
Gender:F
Credentials:AA, BA, AOD CERT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14451 BENEFIT ST
Mailing Address - Street 2:3
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-4052
Mailing Address - Country:US
Mailing Address - Phone:818-625-4922
Mailing Address - Fax:818-788-1390
Practice Address - Street 1:14435 HAMLIN ST
Practice Address - Street 2:102
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-6205
Practice Address - Country:US
Practice Address - Phone:818-997-1930
Practice Address - Fax:818-997-1905
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)