Provider Demographics
NPI:1891128401
Name:MADDOX, SHAYLIN (MFT)
Entity Type:Individual
Prefix:
First Name:SHAYLIN
Middle Name:
Last Name:MADDOX
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:SHAYLIN
Other - Middle Name:
Other - Last Name:EBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:409 ALBERTO WAY
Mailing Address - Street 2:SUITE #5
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-5407
Mailing Address - Country:US
Mailing Address - Phone:408-933-8404
Mailing Address - Fax:
Practice Address - Street 1:15951 LOS GATOS BLVD
Practice Address - Street 2:SUITE #14
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-3428
Practice Address - Country:US
Practice Address - Phone:408-933-8404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 53242106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist