Provider Demographics
NPI:1306478375
Name:COURTNEY SHEN PSYCHOLOGY, INC.
Entity type:Organization
Organization Name:COURTNEY SHEN PSYCHOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:SHEN
Authorized Official - Last Name:DESHETLER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:714-462-3108
Mailing Address - Street 1:3419 E CHAPMAN AVE # 354
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-3812
Mailing Address - Country:US
Mailing Address - Phone:714-785-9592
Mailing Address - Fax:
Practice Address - Street 1:232 W MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7712
Practice Address - Country:US
Practice Address - Phone:714-462-3108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-07
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)