Provider Demographics
NPI:1457721201
Name:SHARLENE SPEIGHTS
Entity Type:Organization
Organization Name:SHARLENE SPEIGHTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE FAMILY THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARLENE
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:SPEIGHTS
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:925-708-3143
Mailing Address - Street 1:191 VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4051
Mailing Address - Country:US
Mailing Address - Phone:925-708-3143
Mailing Address - Fax:925-370-7817
Practice Address - Street 1:191 VISTA WAY
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4051
Practice Address - Country:US
Practice Address - Phone:925-708-3143
Practice Address - Fax:925-370-7817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM15652101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1578722120OtherNPI NUMBER