Provider Demographics
NPI:1538488119
Name:HUEY, SHONTINESE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHONTINESE
Middle Name:
Last Name:HUEY
Suffix:
Gender:F
Credentials:PSYD
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 556
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CA
Mailing Address - Zip Code:95368-0556
Mailing Address - Country:US
Mailing Address - Phone:209-451-9475
Mailing Address - Fax:209-451-9475
Practice Address - Street 1:2291 W MARCH LN STE E-101
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6652
Practice Address - Country:US
Practice Address - Phone:209-451-9475
Practice Address - Fax:209-451-9475
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21817103TC2200X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent