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NPI Code Detail

MEDICARE: MISS SHANNON MAYHALL

MEDICARE: MISS SHANNON MAYHALL
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
1106H00000XMarriage & Family Therapist106177CA
2106H00000XMarriage & Family Therapist106117CA

General Provider Information

NPI Number : 1881876654
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS SHANNON MAYHALL
Provider Business Mailing Address
First Line : 15490 CIVIC DR STE 101
Second Line :
City : VICTORVILLE
State : CA
Zip : 92392-2382
Country : US
Telephone Number : 760-552-9194
Fax Number :
Provider Business Practice Location Address
First Line : 15490 CIVIC DR STE 101
Second Line :
City : VICTORVILLE
State : CA
Zip : 92392-2382
Country : US
Telephone Number : 760-552-9194
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2007
Last Update Date : 01/21/2024

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Directions to “ MISS SHANNON MAYHALL ” Practice Location

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