Provider Demographics
NPI:1972902724
Name:POPE, SHANA CHAN (LMFT)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:CHAN
Last Name:POPE
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 1:11949 JEFFERSON BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6336
Mailing Address - Country:US
Mailing Address - Phone:424-258-5435
Mailing Address - Fax:310-829-9055
Practice Address - Street 1:11949 JEFFERSON BLVD #106
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230
Practice Address - Country:US
Practice Address - Phone:424-258-5435
Practice Address - Fax:310-829-9055
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI587106H00000X
CA77510106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist