Provider Demographics
NPI:1629207022
Name:SHAY, KAREN LOUISE (MFT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LOUISE
Last Name:SHAY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:LOUISE
Other - Last Name:BROSSEAU/BRUNKHORST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:1214 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3230
Mailing Address - Country:US
Mailing Address - Phone:415-257-8344
Mailing Address - Fax:415-479-2945
Practice Address - Street 1:1214 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3230
Practice Address - Country:US
Practice Address - Phone:415-257-8344
Practice Address - Fax:415-479-2945
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT #32828106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist