Provider Demographics
NPI:1306662697
Name:ELHELOU, SHANNEL HELEN KASSIS (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHANNEL
Middle Name:HELEN KASSIS
Last Name:ELHELOU
Suffix:
Gender:F
Credentials:PSYD
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Other - Credentials:
Mailing Address - Street 1:12791 LONE TRAIL CT
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-1168
Mailing Address - Country:US
Mailing Address - Phone:818-800-0514
Mailing Address - Fax:
Practice Address - Street 1:1301 20TH ST STE 150
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2050
Practice Address - Country:US
Practice Address - Phone:310-582-7641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA35236103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist