Healthcare Provider Details

I. General information

NPI: 1518538032
Provider Name (Legal Business Name): SHELBY ANNE ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 CHICAGO AVE STE B
RIVERSIDE CA
92507-2366
US

IV. Provider business mailing address

7308 BLUE OAK RD
RIVERSIDE CA
92507-0140
US

V. Phone/Fax

Practice location:
  • Phone: 951-465-3664
  • Fax:
Mailing address:
  • Phone: 951-345-3863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number120137
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: