Provider Demographics
NPI:1720686041
Name:ALLEN, SHAYLA LORRAINE (AMFT)
Entity Type:Individual
Prefix:MRS
First Name:SHAYLA
Middle Name:LORRAINE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 293084
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95829-3084
Mailing Address - Country:US
Mailing Address - Phone:916-416-5606
Mailing Address - Fax:
Practice Address - Street 1:3671 BUSINESS DR STE 110
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-2233
Practice Address - Country:US
Practice Address - Phone:916-416-5606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT119122106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAMFT119122Medicaid