Healthcare Provider Details

I. General information

NPI: 1710801436
Provider Name (Legal Business Name): SHELBY RAE LAWRENCE M.ED., PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3035 ASH ST
SAN DIEGO CA
92102-1718
US

IV. Provider business mailing address

3180 WEBSTER AVE
SAN DIEGO CA
92113-1434
US

V. Phone/Fax

Practice location:
  • Phone: 619-339-1218
  • Fax:
Mailing address:
  • Phone: 619-339-1218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number260132561
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: