Provider Demographics
NPI:1932298882
Name:SHELLER, KENNETH R (MA)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:R
Last Name:SHELLER
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Gender:M
Credentials:MA
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Mailing Address - Street 1:7281 GARDEN GROVE BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844
Mailing Address - Country:US
Mailing Address - Phone:714-539-4544
Mailing Address - Fax:714-539-5483
Practice Address - Street 1:7281 GARDEN GROVE BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-4212
Practice Address - Country:US
Practice Address - Phone:714-539-4544
Practice Address - Fax:714-539-5483
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)