Provider Demographics
NPI:1184876724
Name:SHINN, JAMES D (LCSW)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:D
Last Name:SHINN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:JAMES
Other - Middle Name:D
Other - Last Name:SHINN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1037 SANDALWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-3825
Mailing Address - Country:US
Mailing Address - Phone:760-353-5059
Mailing Address - Fax:
Practice Address - Street 1:1037 SANDALWOOD DR
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-3825
Practice Address - Country:US
Practice Address - Phone:760-353-5059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 11740103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst