Provider Demographics
NPI:1275631723
Name:SECRIST, SHANNON CHRISTINE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:CHRISTINE
Last Name:SECRIST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1965 LIVE OAK BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-8850
Mailing Address - Country:US
Mailing Address - Phone:530-822-7200
Mailing Address - Fax:530-822-7518
Practice Address - Street 1:1965 LIVE OAK BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-8850
Practice Address - Country:US
Practice Address - Phone:530-822-7200
Practice Address - Fax:530-822-7518
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS235621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical