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General NPI Number Information
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NPI Number | 1518983469
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Entity Type | Individual
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Provider Name | SUSAN C SHELL M.A., M.F.T.
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Gender | Female
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12381 WILSHIRE BLVD SUITE 205
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City | LOS ANGELES
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State | CA
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Zip | 90025-1063
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Country | US
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Telephone | 310-395-6639
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Fax | 310-826-7500
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Provider Business Mailing Address
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Address Line | 12381 WILSHIRE BLVD SUITE 205
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City | LOS ANGELES
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State | CA
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Zip | 90025-1063
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Country | US
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Telephone | 310-395-6639
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Fax | 310-826-7500
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MFC36240
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License Number State | CA
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