Provider Demographics
NPI:1598172843
Name:MARSH, SHAUNA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHAUNA
Middle Name:
Last Name:MARSH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:SHAUNA
Other - Middle Name:MARSH
Other - Last Name:KORTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:12301 WILSHIRE BLVD STE 413
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1051
Mailing Address - Country:US
Mailing Address - Phone:805-233-1776
Mailing Address - Fax:
Practice Address - Street 1:4258 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3706
Practice Address - Country:US
Practice Address - Phone:805-477-5753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-18
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY31034103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist