Provider Demographics
NPI:1750729232
Name:SHANNON STUART-MAVER
Entity type:Organization
Organization Name:SHANNON STUART-MAVER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MARRIAGE & FAMILY THERAPIS
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:STUART-MAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-840-4668
Mailing Address - Street 1:PO BOX 4238
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95518-4238
Mailing Address - Country:US
Mailing Address - Phone:707-840-4668
Mailing Address - Fax:707-822-3999
Practice Address - Street 1:801 CRESCENT WAY
Practice Address - Street 2:SUITE 3
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6780
Practice Address - Country:US
Practice Address - Phone:707-840-4668
Practice Address - Fax:707-822-3999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 46239106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty