Provider Demographics
NPI:1316154123
Name:SHENK, JAMES L (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:SHENK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3262 HOLIDAY CT
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-0026
Mailing Address - Country:US
Mailing Address - Phone:858-450-1101
Mailing Address - Fax:858-450-1161
Practice Address - Street 1:3262 HOLIDAY CT
Practice Address - Street 2:SUITE 220
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-0026
Practice Address - Country:US
Practice Address - Phone:858-450-1101
Practice Address - Fax:858-450-1161
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY11550103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWCP11550AMedicare ID - Type UnspecifiedPPIN