Healthcare Provider Details

I. General information

NPI: 1689140303
Provider Name (Legal Business Name): SHANE MICHAEL BESS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2018
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3741 VIA MARINA AVE
OXNARD CA
93035-2220
US

IV. Provider business mailing address

3741 VIA MARINA AVE
OXNARD CA
93035-2220
US

V. Phone/Fax

Practice location:
  • Phone: 805-377-4112
  • Fax:
Mailing address:
  • Phone: 805-377-4112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number144257
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: