Provider Demographics
NPI:1184288516
Name:ONCE UPON A TIME FAMILY THERAPY CENTER
Entity type:Organization
Organization Name:ONCE UPON A TIME FAMILY THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:S
Authorized Official - Last Name:O'SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:530-263-8995
Mailing Address - Street 1:PO BOX 2344
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-2344
Mailing Address - Country:US
Mailing Address - Phone:530-264-6144
Mailing Address - Fax:
Practice Address - Street 1:696 WHITING ST
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-7543
Practice Address - Country:US
Practice Address - Phone:530-263-8995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-01
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty