Provider Demographics
NPI:1053798868
Name:SHEA, JODIE ELIZABETH (LMFT)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:ELIZABETH
Last Name:SHEA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JODIE
Other - Middle Name:ELIZABETH
Other - Last Name:LAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25645 CROSS CREEK DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-6283
Mailing Address - Country:US
Mailing Address - Phone:661-772-9784
Mailing Address - Fax:
Practice Address - Street 1:25645 CROSS CREEK DR UNIT A
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887-6283
Practice Address - Country:US
Practice Address - Phone:661-772-9784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-30
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA113965106H00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor