Healthcare Provider Details

I. General information

NPI: 1205472891
Provider Name (Legal Business Name): BOBBI SHEPLOR COUNSELOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 04/27/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40700 CALIFORNAIA OAKS RD
MURRIETA CA
92562
US

IV. Provider business mailing address

993 POSTAL WAY
VISTA CA
92083-6945
US

V. Phone/Fax

Practice location:
  • Phone: 951-894-5072
  • Fax: 951-894-7324
Mailing address:
  • Phone: 760-630-9922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1331131218
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: