Provider Demographics
NPI:1538291695
Name:MC DONALD, SHANNYN CORRYN (MA MFTI)
Entity Type:Individual
Prefix:MS
First Name:SHANNYN
Middle Name:CORRYN
Last Name:MC DONALD
Suffix:
Gender:F
Credentials:MA MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 E HACKETT RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95358-9415
Mailing Address - Country:US
Mailing Address - Phone:209-558-3465
Mailing Address - Fax:
Practice Address - Street 1:251 E HACKETT RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95358-9415
Practice Address - Country:US
Practice Address - Phone:209-558-3465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 43022106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist