Provider Demographics
NPI:1134998032
Name:THORNTON-BEY, SHANNON MARIA
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:MARIA
Last Name:THORNTON-BEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16250 HOMECOMING DR UNIT 1248
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91708-8821
Mailing Address - Country:US
Mailing Address - Phone:571-528-1669
Mailing Address - Fax:
Practice Address - Street 1:16250 HOMECOMING DR UNIT 1248
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91708-8821
Practice Address - Country:US
Practice Address - Phone:571-528-1669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15369101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional