Provider Demographics
NPI:1659041366
Name:SHAMBROOK, PATRICIA LYNN (MA)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:LYNN
Last Name:SHAMBROOK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:PATTI
Other - Middle Name:
Other - Last Name:SHAMBROOK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:195 S JAMESON ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2210
Mailing Address - Country:US
Mailing Address - Phone:714-651-8280
Mailing Address - Fax:
Practice Address - Street 1:4060 CAMPUS DR STE 110
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2205
Practice Address - Country:US
Practice Address - Phone:714-651-8280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88618106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist