Provider Demographics
NPI:1659514156
Name:ORNELLAS, SHAUNA MARIE (MFT)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:MARIE
Last Name:ORNELLAS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:SHAUNA
Other - Middle Name:MARIE
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27201 PUERTA REAL STE 300
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-8590
Mailing Address - Country:US
Mailing Address - Phone:949-466-4618
Mailing Address - Fax:
Practice Address - Street 1:25431 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 260
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-466-4618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45023106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist