Provider Demographics
NPI:1689701070
Name:STECK, SHANNON L (RN MFT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:L
Last Name:STECK
Suffix:
Gender:F
Credentials:RN MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4405 RIVERSIDE DRIVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4050
Mailing Address - Country:US
Mailing Address - Phone:818-845-0730
Mailing Address - Fax:
Practice Address - Street 1:4405 RIVERSIDE DRIVE
Practice Address - Street 2:SUITE 106
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4050
Practice Address - Country:US
Practice Address - Phone:818-845-0730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC22501106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist