Provider Demographics
NPI:1386086486
Name:SHEN, CHARLES (MFT-TRAINEE)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:SHEN
Suffix:
Gender:M
Credentials:MFT-TRAINEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2523 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-3801
Mailing Address - Country:US
Mailing Address - Phone:213-480-1557
Mailing Address - Fax:213-480-1182
Practice Address - Street 1:2523 W 7TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3801
Practice Address - Country:US
Practice Address - Phone:213-480-1557
Practice Address - Fax:213-480-1182
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAIMF81706106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program