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General NPI Number Information
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NPI Number | 1962938340
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Entity Type | Individual
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Provider Name | SHAYLAH ANDERSON
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Gender | Female
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Dates
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Enumeration Date | 05/04/2017
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 3847 E14TH ST #215
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City | SAN LEANDRO
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State | CA
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Zip | 94578
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Country | US
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Telephone | 510-430-1115
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Fax |
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Provider Business Mailing Address
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Address Line | 4061 E CASTRO VALLEY BLVD STE 161
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City | CASTRO VALLEY
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State | CA
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Zip | 94552-4840
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Country | US
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Telephone | 510-463-4204
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3830
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 8134
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License Number State | CA
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