Provider Demographics
NPI:1750827291
Name:SHIN, CONSTANCE (LMFT)
Entity Type:Individual
Prefix:MISS
First Name:CONSTANCE
Middle Name:
Last Name:SHIN
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 1:4010 WATSON PLAZA DR
Mailing Address - Street 2:SUITE 285
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-4037
Mailing Address - Country:US
Mailing Address - Phone:562-497-1505
Mailing Address - Fax:562-497-1881
Practice Address - Street 1:4010 WATSON PLAZA DR
Practice Address - Street 2:SUITE 285
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-4037
Practice Address - Country:US
Practice Address - Phone:562-497-1505
Practice Address - Fax:562-497-1881
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48639106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist