Provider Demographics
NPI:1407298995
Name:SHEALY, PATRICIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:SHEALY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 REDCLIFF DR STE 235
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-0102
Mailing Address - Country:US
Mailing Address - Phone:831-582-7475
Mailing Address - Fax:530-255-8509
Practice Address - Street 1:429 REDCLIFF DR STE 235
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0102
Practice Address - Country:US
Practice Address - Phone:831-582-7475
Practice Address - Fax:530-255-8509
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC22662106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1407298995OtherMARRIAGE FAMILY THERAPIST