Healthcare Provider Details

I. General information

NPI: 1053220186
Provider Name (Legal Business Name): SHANISE MOK AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

987 UNIVERSITY AVE STE 22
LOS GATOS CA
95032-7640
US

IV. Provider business mailing address

PO BOX 320214
LOS GATOS CA
95032-0103
US

V. Phone/Fax

Practice location:
  • Phone: 408-722-3770
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164358
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: