Provider Demographics
NPI:1518415215
Name:HARRELL, SHELLY P (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:P
Last Name:HARRELL
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 1:10700 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4768
Mailing Address - Country:US
Mailing Address - Phone:424-209-2223
Mailing Address - Fax:888-380-7835
Practice Address - Street 1:10700 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 315
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4768
Practice Address - Country:US
Practice Address - Phone:424-209-2223
Practice Address - Fax:888-380-7835
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11531103T00000X, 103TC0700X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service