Provider Demographics
NPI:1386874626
Name:OLIVEIRA, SHANNON JENNIFER (LMFT)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:JENNIFER
Last Name:OLIVEIRA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 600014
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92160-0014
Mailing Address - Country:US
Mailing Address - Phone:707-738-3453
Mailing Address - Fax:
Practice Address - Street 1:4740 MISSION GORGE PL UNIT 600014
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92160-7002
Practice Address - Country:US
Practice Address - Phone:707-738-3453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAIMF 57624106H00000X
CA100161106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health