Provider Demographics
NPI:1053628412
Name:HUCKESTEIN, SHANNON KELLI
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:KELLI
Last Name:HUCKESTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 SEABRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-1453
Mailing Address - Country:US
Mailing Address - Phone:805-320-0313
Mailing Address - Fax:
Practice Address - Street 1:333 W HARVARD BLVD
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-3225
Practice Address - Country:US
Practice Address - Phone:805-525-1618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist