Provider Demographics
NPI:1386894343
Name:FURUTA, SHELLIE DANIELLE (MA, MFT)
Entity type:Individual
Prefix:
First Name:SHELLIE
Middle Name:DANIELLE
Last Name:FURUTA
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1094 CUDAHY PL STE 314
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3924
Mailing Address - Country:US
Mailing Address - Phone:619-275-0822
Mailing Address - Fax:619-275-5069
Practice Address - Street 1:1094 CUDAHY PL STE 314
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3924
Practice Address - Country:US
Practice Address - Phone:619-275-0822
Practice Address - Fax:619-275-5069
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 48334106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist