Provider Demographics
NPI:1518135482
Name:HOUSELOG, SHANNON (LCSW)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:HOUSELOG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 E PALMDALE BLVD
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-4756
Mailing Address - Country:US
Mailing Address - Phone:661-274-0770
Mailing Address - Fax:661-274-9970
Practice Address - Street 1:1020 E PALMDALE BLVD
Practice Address - Street 2:SUITE 101B
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4756
Practice Address - Country:US
Practice Address - Phone:661-274-0770
Practice Address - Fax:661-274-9970
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW656721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical