Provider Demographics
NPI:1265868772
Name:DEGUIRE, SHAUNA LEIGH
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:LEIGH
Last Name:DEGUIRE
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 1:14011 RICES CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:NORTH SAN JUAN
Mailing Address - State:CA
Mailing Address - Zip Code:95960-9542
Mailing Address - Country:US
Mailing Address - Phone:510-345-2508
Mailing Address - Fax:
Practice Address - Street 1:607 SISKIYOU BLVD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2139
Practice Address - Country:US
Practice Address - Phone:541-482-1718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA390200000X
CAIMF83399106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program