Provider Demographics
NPI:1639641491
Name:AGUIRRE, SHANNON LI STARZECKI (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LI STARZECKI
Last Name:AGUIRRE
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S MCCLELLAND ST STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5186
Mailing Address - Country:US
Mailing Address - Phone:805-459-0940
Mailing Address - Fax:
Practice Address - Street 1:505 S MCCLELLAND ST STE A
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5186
Practice Address - Country:US
Practice Address - Phone:805-459-0940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108724106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty