Provider Demographics
NPI:1215113501
Name:HELMLE, SHANNON (LMFT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:HELMLE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:CEDAR GLEN
Mailing Address - State:CA
Mailing Address - Zip Code:92321-0151
Mailing Address - Country:US
Mailing Address - Phone:909-645-7682
Mailing Address - Fax:
Practice Address - Street 1:150 PAULARINO AVE
Practice Address - Street 2:STE: 185
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-3301
Practice Address - Country:US
Practice Address - Phone:909-645-7682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist