Provider Demographics
NPI:1356771430
Name:BRINKLEY, SHAWN LARE (LMFT)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:LARE
Last Name:BRINKLEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12334 CARL ST
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-1467
Mailing Address - Country:US
Mailing Address - Phone:818-359-6921
Mailing Address - Fax:747-225-0696
Practice Address - Street 1:18719 CALVERT ST
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91335
Practice Address - Country:US
Practice Address - Phone:818-798-3201
Practice Address - Fax:747-225-0696
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2018-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102664106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA102664OtherLMFT