Provider Demographics
NPI:1588029631
Name:CHANG, SHAWN COLLEEN
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:COLLEEN
Last Name:CHANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 CALLE TAXCO
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-2171
Mailing Address - Country:US
Mailing Address - Phone:626-991-1386
Mailing Address - Fax:
Practice Address - Street 1:500 N EUCLID ST STE 300
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5510
Practice Address - Country:US
Practice Address - Phone:714-871-5646
Practice Address - Fax:714-817-7368
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health