=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154669604
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHANNON DOBBS PSY.D CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2013
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28310 ROADSIDE DR STE 203
-----------------------------------------------------
City | AGOURA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91301-4958
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-428-2431
-----------------------------------------------------
Fax | 800-713-1290
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2060D E AVENIDA DE LOS ARBOLES # 239
-----------------------------------------------------
City | THOUSAND OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91362-1376
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-428-2431
-----------------------------------------------------
Fax | 800-713-1290
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | MS. SHANNON DOBBS
-----------------------------------------------------
Credential | PSY.D
-----------------------------------------------------
Telephone | 310-428-2431
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------