MEDICARE: SHELLY WARE LMFT

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
1	106H00000X	Marriage & Family Therapist	LMFT101206	CA

General Provider Information

NPI Number	:	1790069078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLY WARE LMFT

Provider Business Mailing Address
First Line	:	178 W 68TH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-1109
Country	:	US
Telephone Number	:	562-275-8371
Fax Number	:

Provider Business Practice Location Address
First Line	:	4906 E LOS COYOTES DIAGONAL
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-2837
Country	:	US
Telephone Number	:	562-275-8371
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2011
Last Update Date	:	09/19/2018

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