Provider Demographics
NPI:1023136355
Name:WATTERS, SHANEY ALYNNE (MFT)
Entity type:Individual
Prefix:MRS
First Name:SHANEY
Middle Name:ALYNNE
Last Name:WATTERS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 ROBINSON AVE
Mailing Address - Street 2:SUITE # 204
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-7633
Mailing Address - Country:US
Mailing Address - Phone:619-228-5840
Mailing Address - Fax:
Practice Address - Street 1:7339 EL CAJON BLVD
Practice Address - Street 2:SUITE K
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-3435
Practice Address - Country:US
Practice Address - Phone:619-668-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41333106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist