Provider Demographics
NPI:1407134190
Name:SANTHON, SHANNON (MFT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:SANTHON
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 1:17280 NEWHOPE ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4270
Mailing Address - Country:US
Mailing Address - Phone:714-434-3980
Mailing Address - Fax:714-434-3981
Practice Address - Street 1:17280 NEWHOPE ST
Practice Address - Street 2:SUITE 4
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4270
Practice Address - Country:US
Practice Address - Phone:714-434-3980
Practice Address - Fax:714-434-3981
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36067106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist