Provider Demographics
NPI:1922860477
Name:JARVIE, SHAYNE (BA PSYCHOLOGY)
Entity Type:Individual
Prefix:
First Name:SHAYNE
Middle Name:
Last Name:JARVIE
Suffix:
Gender:F
Credentials:BA PSYCHOLOGY
Other - Prefix:
Other - First Name:SHAYNA
Other - Middle Name:
Other - Last Name:JARVIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:531 K ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-1146
Mailing Address - Country:US
Mailing Address - Phone:707-441-4115
Mailing Address - Fax:
Practice Address - Street 1:3 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-0241
Practice Address - Country:US
Practice Address - Phone:707-442-2213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator