Provider Demographics
NPI:1801201595
Name:SHANNON, JEFF ANDREW (LMFT)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:ANDREW
Last Name:SHANNON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 S C. ST.
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-4574
Mailing Address - Country:US
Mailing Address - Phone:510-390-2864
Mailing Address - Fax:
Practice Address - Street 1:2500 S C ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-4560
Practice Address - Country:US
Practice Address - Phone:510-390-2864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-22
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 35848106H00000X
CA35848106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist