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General NPI Number Information
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NPI Number | 1861713463
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Entity Type | Individual
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Provider Name | SHANNON KENNEDY
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Gender | Female
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Dates
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Enumeration Date | 06/17/2010
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Last Update Date | 01/19/2015
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Provider Practice Location Address
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Address Line | 22 W MICHELTORENA ST STE A
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City | SANTA BARBARA
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State | CA
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Zip | 93101-6526
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Country | US
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Telephone | 805-317-6816
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Fax |
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Provider Business Mailing Address
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Address Line | 758 OAK WALK D
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City | GOLETA
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State | CA
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Zip | 93117-3035
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Country | US
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Telephone | 646-263-6812
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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 | 84822
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License Number State | CA
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