Provider Demographics
NPI:1457374043
Name:SHIMMEL, MARYELLEN A (RN, MFT)
Entity Type:Individual
Prefix:
First Name:MARYELLEN
Middle Name:A
Last Name:SHIMMEL
Suffix:
Gender:F
Credentials:RN, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6316 PALMBROOK CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-7490
Mailing Address - Country:US
Mailing Address - Phone:661-872-9089
Mailing Address - Fax:661-872-9089
Practice Address - Street 1:5401 BUSINESS PARK S
Practice Address - Street 2:SUITE #100
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0721
Practice Address - Country:US
Practice Address - Phone:661-703-4787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29276101YM0800X
CA225887163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163W00000XNursing Service ProvidersRegistered Nurse