Provider Demographics
NPI:1952865586
Name:SHLAIN, JACQUELINE (LMFT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:SHLAIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9713 SANTA MONICA BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4237
Mailing Address - Country:US
Mailing Address - Phone:866-474-7444
Mailing Address - Fax:
Practice Address - Street 1:9713 SANTA MONICA BLVD STE 202
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4237
Practice Address - Country:US
Practice Address - Phone:866-474-7444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT115150106H00000X
390200000X
CA142832106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program