Provider Demographics
NPI:1407253495
Name:TAPIA, SHELLIE SUZANNE (LMFT, RBT)
Entity Type:Individual
Prefix:MRS
First Name:SHELLIE
Middle Name:SUZANNE
Last Name:TAPIA
Suffix:
Gender:F
Credentials:LMFT, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10777 CIVIC CENTER DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3806
Mailing Address - Country:US
Mailing Address - Phone:909-948-3536
Mailing Address - Fax:
Practice Address - Street 1:10777 CIVIC CENTER DR
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3806
Practice Address - Country:US
Practice Address - Phone:909-948-3536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-19
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-16-18596106S00000X
CA83377106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician