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General NPI Number Information
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NPI Number | 1649091125
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Entity Type | Individual
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Provider Name | TINA SHAMEON
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Gender | Female
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Dates
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Enumeration Date | 10/18/2024
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 2512 FOOTHILL BLVD
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City | LA CRESCENTA
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State | CA
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Zip | 91214-3506
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Country | US
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Telephone | 818-570-0721
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Fax |
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Provider Business Mailing Address
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Address Line | 5417 ZELZAH AVE APT 304
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City | ENCINO
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State | CA
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Zip | 91316-2285
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Country | US
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Telephone | 818-921-2534
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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 | 150196
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License Number State | CA
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