Provider Demographics
NPI:1710506381
Name:HAMILTON, SHAUNA ROSE (LMFT)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:ROSE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-3714
Mailing Address - Country:US
Mailing Address - Phone:707-849-4810
Mailing Address - Fax:
Practice Address - Street 1:831 HOWARD ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-3714
Practice Address - Country:US
Practice Address - Phone:707-849-4810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA116907101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor