Provider Demographics
NPI:1851167100
Name:LA VOYN-SALLIS, SHELAH
Entity Type:Individual
Prefix:
First Name:SHELAH
Middle Name:
Last Name:LA VOYN-SALLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31754 TEMECULA PKWY # A590
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-6814
Mailing Address - Country:US
Mailing Address - Phone:858-844-6915
Mailing Address - Fax:858-422-3120
Practice Address - Street 1:31754 TEMECULA PKWY # A590
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-6814
Practice Address - Country:US
Practice Address - Phone:858-844-6915
Practice Address - Fax:858-422-3120
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA141970106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist