Provider Demographics
NPI:1629732169
Name:PHYPPS, SHAWNTEL
Entity Type:Individual
Prefix:
First Name:SHAWNTEL
Middle Name:
Last Name:PHYPPS
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 1:9040 TELSTAR AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2838
Mailing Address - Country:US
Mailing Address - Phone:626-774-5809
Mailing Address - Fax:
Practice Address - Street 1:9040 TELSTAR AVE STE 101
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2838
Practice Address - Country:US
Practice Address - Phone:626-774-5809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAACSW102265104100000X
CAASW1022651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty