Provider Demographics
NPI:1700079472
Name:SHALLENBERGER, TERRI ANN (MS, LMFT)
Entity Type:Individual
Prefix:MISS
First Name:TERRI
Middle Name:ANN
Last Name:SHALLENBERGER
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 HARBOR BLVD
Mailing Address - Street 2:#8
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-1131
Mailing Address - Country:US
Mailing Address - Phone:818-399-8147
Mailing Address - Fax:
Practice Address - Street 1:1013 HARBOR BLVD
Practice Address - Street 2:#8
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93035-1131
Practice Address - Country:US
Practice Address - Phone:818-399-8147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2020-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT41502106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist