Provider Demographics
NPI:1780829135
Name:KARIM, SHANNON (MA)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:
Last Name:KARIM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:FENCHACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:5150 E PACIFIC COAST HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3394
Mailing Address - Country:US
Mailing Address - Phone:562-490-7600
Mailing Address - Fax:562-490-7601
Practice Address - Street 1:5150 E PACIFIC COAST HWY STE 100
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3394
Practice Address - Country:US
Practice Address - Phone:562-490-7600
Practice Address - Fax:562-490-7601
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT78385106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist