Healthcare Provider Details

I. General information

NPI: 1184342081
Provider Name (Legal Business Name): VILLAGE COLLABORATION STATION, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2721 E MAIN ST
VENTURA CA
93003-2803
US

IV. Provider business mailing address

PO BOX 2312
CAMARILLO CA
93011-2312
US

V. Phone/Fax

Practice location:
  • Phone: 805-667-2841
  • Fax: 805-948-2846
Mailing address:
  • Phone: 805-603-9237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIELLE SHAW
Title or Position: CEO
Credential: MD
Phone: 805-479-7905