Provider Demographics
NPI:1497103683
Name:FELDMAN, SHANNON (MS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1561
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95009-1561
Mailing Address - Country:US
Mailing Address - Phone:408-637-7450
Mailing Address - Fax:
Practice Address - Street 1:2155 S BASCOM AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-3272
Practice Address - Country:US
Practice Address - Phone:408-637-7450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC91146106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist