Provider Demographics
NPI:1508204470
Name:BEHAR, SHANNON MICHELLE X (MA)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:MICHELLE
Last Name:BEHAR
Suffix:X
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12148 LOUISE AVE
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-1930
Mailing Address - Country:US
Mailing Address - Phone:818-929-2189
Mailing Address - Fax:
Practice Address - Street 1:20350 VENTURA BLVD STE 230
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2487
Practice Address - Country:US
Practice Address - Phone:818-226-6070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71902101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health