Healthcare Provider Details

I. General information

NPI: 1407460967
Provider Name (Legal Business Name): MRS. SHELBY DENAI KENDRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 17671
SAN DIEGO CA
92177-7671
US

IV. Provider business mailing address

PO BOX 17671
SAN DIEGO CA
92177-7671
US

V. Phone/Fax

Practice location:
  • Phone: 602-228-6812
  • Fax:
Mailing address:
  • Phone: 602-228-6812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number22487
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: