Provider Demographics
NPI:1669599759
Name:SHOCKNEY, STEPHANIE JOY (MFT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JOY
Last Name:SHOCKNEY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11731 TELEGRAPH RD STE G
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-6819
Mailing Address - Country:US
Mailing Address - Phone:562-942-8256
Mailing Address - Fax:
Practice Address - Street 1:11731 TELEGRAPH RD STE G
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-6819
Practice Address - Country:US
Practice Address - Phone:562-942-8256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 47985101YM0800X
CALMFT91323106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health