Provider Demographics
NPI:1528460995
Name:COLLINS RAWLE, SHELLY-ANN
Entity type:Individual
Prefix:
First Name:SHELLY-ANN
Middle Name:
Last Name:COLLINS RAWLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 E OCEAN BLVD UNIT 707
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-5450
Mailing Address - Country:US
Mailing Address - Phone:818-863-6465
Mailing Address - Fax:617-983-1377
Practice Address - Street 1:850 E OCEAN BLVD UNIT 707
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-5450
Practice Address - Country:US
Practice Address - Phone:818-863-6465
Practice Address - Fax:240-559-9576
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA30508103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program