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General NPI Number Information
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NPI Number | 1801349972
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Entity Type | Individual
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Provider Name | KRISTY SHANKS LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/26/2016
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Last Update Date | 11/05/2021
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Provider Practice Location Address
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Address Line | 5297 COLLEGE AVE STE 103
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City | OAKLAND
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State | CA
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Zip | 94618-1797
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Country | US
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Telephone | 510-788-0005
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Fax |
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Provider Business Mailing Address
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Address Line | 2828 COLLEGE AVE APT 17
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City | BERKELEY
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State | CA
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Zip | 94705-2138
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Country | US
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Telephone | 608-214-0657
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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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 | 84091
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 84091
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 103353
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License Number State | CA
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