Provider Demographics
NPI:1952075673
Name:GARTH, SHANEEN
Entity Type:Individual
Prefix:
First Name:SHANEEN
Middle Name:
Last Name:GARTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 S WESTERN AVE APT 110
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-3171
Mailing Address - Country:US
Mailing Address - Phone:424-288-1904
Mailing Address - Fax:
Practice Address - Street 1:1250 S WESTERN AVE APT 110
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-3171
Practice Address - Country:US
Practice Address - Phone:424-288-1904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst