Provider Demographics
NPI:1316074487
Name:WILSON-MCGEE, SHANTEL JONQUEL (MS)
Entity type:Individual
Prefix:MRS
First Name:SHANTEL
Middle Name:JONQUEL
Last Name:WILSON-MCGEE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 W FORHAN ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-2119
Mailing Address - Country:US
Mailing Address - Phone:562-428-0078
Mailing Address - Fax:
Practice Address - Street 1:1303 W WALNUT PKWY
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-5030
Practice Address - Country:US
Practice Address - Phone:562-208-9492
Practice Address - Fax:310-868-5398
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101395106H00000X
CAIMF88785101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health