Provider Demographics
NPI:1841405586
Name:HANRAHAN, SHANNON EILEEN (PSY AND MFT)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:EILEEN
Last Name:HANRAHAN
Suffix:
Gender:F
Credentials:PSY AND MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 W SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1829
Mailing Address - Country:US
Mailing Address - Phone:714-928-9580
Mailing Address - Fax:714-447-9807
Practice Address - Street 1:227 W SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1829
Practice Address - Country:US
Practice Address - Phone:714-928-9580
Practice Address - Fax:714-447-9807
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 34839106H00000X
CAPSY 23375103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM351247YKWYOtherPTAN