Healthcare Provider Details

I. General information

NPI: 1245720960
Provider Name (Legal Business Name): SH SQUARED CARES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S MAIN ST STE 202
TEMPLETON CA
93465-9350
US

IV. Provider business mailing address

212 S MAIN ST STE 202
TEMPLETON CA
93465-9350
US

V. Phone/Fax

Practice location:
  • Phone: 58-369-2239
  • Fax:
Mailing address:
  • Phone: 58-369-2239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY28777
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP25805
License Number StateCA

VIII. Authorized Official

Name: DR. STACY LYNN HUTTON
Title or Position: PARTNER
Credential: PHD
Phone: 805-369-2239