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General NPI Number Information
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NPI Number | 1851436976
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Entity Type | Individual
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Provider Name | DR. SHANNON LEIGH STUART-MAVER
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Gender | Female
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 1977 LESLIE CT
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City | ARCATA
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State | CA
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Zip | 95521-4754
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Country | US
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Telephone | 707-840-4668
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10
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City | ARCATA
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State | CA
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Zip | 95518-0010
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Country | US
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Telephone | 707-840-4668
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPCC1154
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 34386
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 46239
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3655
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License Number State | OR
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