Provider Demographics
NPI:1275632986
Name:SHIFFLETT-COLLINS, KAREN KAY (MFT)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:KAY
Last Name:SHIFFLETT-COLLINS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3532 KATELLA AVE STE 223
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3161
Mailing Address - Country:US
Mailing Address - Phone:714-878-6221
Mailing Address - Fax:
Practice Address - Street 1:3532 KATELLA AVE STE 223
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3161
Practice Address - Country:US
Practice Address - Phone:714-878-6221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 39961106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist