Provider Demographics
NPI:1932352606
Name:SHELL, LAVERNE JEANENE (MFT)
Entity Type:Individual
Prefix:MRS
First Name:LAVERNE
Middle Name:JEANENE
Last Name:SHELL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 PICKWICK CT
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-3457
Mailing Address - Country:US
Mailing Address - Phone:916-944-8491
Mailing Address - Fax:916-972-7746
Practice Address - Street 1:4144 WINDING WAY
Practice Address - Street 2:SUITE 113
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-3457
Practice Address - Country:US
Practice Address - Phone:916-944-8491
Practice Address - Fax:916-972-7746
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27512106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist