Provider Demographics
NPI:1386835635
Name:LAWLER, SHANNON (MFTI)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:LAWLER
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2198 6TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-2233
Mailing Address - Country:US
Mailing Address - Phone:510-848-1112
Mailing Address - Fax:510-848-4445
Practice Address - Street 1:2198 6TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-2233
Practice Address - Country:US
Practice Address - Phone:510-848-1112
Practice Address - Fax:510-848-4445
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFTI53277106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01CROtherMEDI-CAL