Provider Demographics
NPI:1588017156
Name:ERNOEHAZY, SHAWN (MFT)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:ERNOEHAZY
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 1:420 FOLSOM RD STE C
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-2767
Mailing Address - Country:US
Mailing Address - Phone:916-412-3240
Mailing Address - Fax:
Practice Address - Street 1:420 FOLSOM RD STE C
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-2767
Practice Address - Country:US
Practice Address - Phone:916-412-3240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT93942106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist