Healthcare Provider Details

I. General information

NPI: 1750891321
Provider Name (Legal Business Name): STEPHANIE SHREVE PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 10/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13500 AIRPORT RD
BOONVILLE CA
95415-9133
US

IV. Provider business mailing address

PO BOX 338
BOONVILLE CA
95415-0338
US

V. Phone/Fax

Practice location:
  • Phone: 707-895-3477
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number29428
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: