Healthcare Provider Details

I. General information

NPI: 1760638753
Provider Name (Legal Business Name): ORLY SHABBOUI M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2008
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 S BEVERLY DR STE 100
BEVERLY HILLS CA
90212-4410
US

IV. Provider business mailing address

420 S BEVERLY DR STE 100
BEVERLY HILLS CA
90212-4410
US

V. Phone/Fax

Practice location:
  • Phone: 888-348-6988
  • Fax:
Mailing address:
  • Phone: 888-348-6988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT49522
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: