Provider Demographics
NPI:1467965475
Name:SHORELINE MENTAL HEALTH, INC
Entity Type:Organization
Organization Name:SHORELINE MENTAL HEALTH, INC
Other - Org Name:SHORELINE MENTAL HEALTH, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ZARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHIKYAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:562-493-6799
Mailing Address - Street 1:610 PACIFIC COAST HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6650
Mailing Address - Country:US
Mailing Address - Phone:562-493-6799
Mailing Address - Fax:562-493-6578
Practice Address - Street 1:610 PACIFIC COAST HWY STE 201
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6650
Practice Address - Country:US
Practice Address - Phone:562-493-6799
Practice Address - Fax:562-493-6578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21081103TC0700X
CAA1170292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2325680OtherHEALTHNET
CA2357845OtherHEALTHNET
CA2107587OtherHEALTHNET