Provider Demographics
NPI:1376876375
Name:ZAVALA, SHELLY (MFT, PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:
Last Name:ZAVALA
Suffix:
Gender:F
Credentials:MFT, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 DOVE STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:949-752-7955
Mailing Address - Fax:949-752-7955
Practice Address - Street 1:1151 DOVE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2840
Practice Address - Country:US
Practice Address - Phone:949-752-7955
Practice Address - Fax:949-752-7955
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT39381106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist