Provider Demographics
NPI:1225512569
Name:MCPHETRIDGE, SHAINA (LMFT 109471)
Entity Type:Individual
Prefix:
First Name:SHAINA
Middle Name:
Last Name:MCPHETRIDGE
Suffix:
Gender:F
Credentials:LMFT 109471
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 ARMACOST AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2718
Mailing Address - Country:US
Mailing Address - Phone:616-340-1433
Mailing Address - Fax:
Practice Address - Street 1:3301 OCEAN PARK BLVD STE 109
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3223
Practice Address - Country:US
Practice Address - Phone:616-340-1433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-22
Last Update Date:2018-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LMFT109471106H00000X
CA109471106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist