Provider Demographics
NPI:1568634012
Name:WAPSTRA SCOTT, SHANA (MFT)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:WAPSTRA SCOTT
Suffix:
Gender:F
Credentials:MFT
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 9302
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96162-7302
Mailing Address - Country:US
Mailing Address - Phone:775-825-2777
Mailing Address - Fax:775-825-6090
Practice Address - Street 1:10356 DONNER PASS RD
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0315
Practice Address - Country:US
Practice Address - Phone:775-825-2777
Practice Address - Fax:775-825-6090
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33369106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist