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NPI Code Detail

MEDICARE: SHAMARIAH LA MAE HENDLEY MHRS

MEDICARE: SHAMARIAH LA MAE HENDLEY MHRS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician
2101YM0800XMental Health CounselorCA

General Provider Information

NPI Number : 1134776883
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAMARIAH LA MAE HENDLEY MHRS
Provider Business Mailing Address
First Line : 8001 PALM ST
Second Line :
City : LEMON GROVE
State : CA
Zip : 91945-3026
Country : US
Telephone Number : 619-797-1090
Fax Number :
Provider Business Practice Location Address
First Line : 8001 PALM ST
Second Line :
City : LEMON GROVE
State : CA
Zip : 91945-3026
Country : US
Telephone Number : 619-797-1090
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2019
Last Update Date : 11/15/2019

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