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General NPI Number Information
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NPI Number | 1043489628
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Entity Type | Individual
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Provider Name | BITA RAQUELLE SHOOSHANI MS, LMHC, LMFT
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Gender | Female
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Dates
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Enumeration Date | 02/27/2008
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Last Update Date | 09/25/2019
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Provider Practice Location Address
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Address Line | 3225 LAKESHORE AVE
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City | OAKLAND
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State | CA
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Zip | 94610-2719
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Country | US
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Telephone | 401-500-6319
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Fax |
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Provider Business Mailing Address
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Address Line | 5000 MACARTHUR BLVD # 9703
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City | OAKLAND
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State | CA
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Zip | 94613-1301
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Country | US
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Telephone | 401-500-6319
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 42182
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MHC00619
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License Number State | RI
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