Provider Demographics
NPI:1598828238
Name:SHERIDAN, SHANNON THERESA (MFT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:THERESA
Last Name:SHERIDAN
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 1:341 BROADWAY ST STE 203
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-5355
Mailing Address - Country:US
Mailing Address - Phone:530-343-9446
Mailing Address - Fax:530-343-9446
Practice Address - Street 1:341 BROADWAY ST STE 203
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-5355
Practice Address - Country:US
Practice Address - Phone:530-343-9446
Practice Address - Fax:530-343-9446
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29712101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health