Provider Demographics
NPI:1356189237
Name:SHURTLEFF, MARILYN REBEKAH
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:REBEKAH
Last Name:SHURTLEFF
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:PO BOX 8236
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96162-8236
Mailing Address - Country:US
Mailing Address - Phone:916-287-0635
Mailing Address - Fax:
Practice Address - Street 1:6135 KING RD STE D
Practice Address - Street 2:
Practice Address - City:LOOMIS
Practice Address - State:CA
Practice Address - Zip Code:95650-8877
Practice Address - Country:US
Practice Address - Phone:916-287-0635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA131227106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist