Provider Demographics
NPI:1770004103
Name:STONE, SHELBY CLAIRE (LMFT)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:CLAIRE
Last Name:STONE
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 1:1452 26TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-3085
Mailing Address - Country:US
Mailing Address - Phone:424-645-7754
Mailing Address - Fax:
Practice Address - Street 1:1452 26TH ST STE 203
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-3085
Practice Address - Country:US
Practice Address - Phone:424-645-7754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112223106H00000X
CAIMF99980106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist