Healthcare Provider Details

I. General information

NPI: 1295135291
Provider Name (Legal Business Name): CHANELL SHAVERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5408 SILVER CROSSING ST
BAKERSFIELD CA
93313-4123
US

IV. Provider business mailing address

5408 SILVER CROSSING ST
BAKERSFIELD CA
93313-4123
US

V. Phone/Fax

Practice location:
  • Phone: 661-331-8313
  • Fax:
Mailing address:
  • Phone: 661-331-8313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSB94029666
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number121012
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF80029
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT121012
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: