Provider Demographics
NPI:1699132530
Name:GREGORY, SHELLEY (LMFT)
Entity type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:
Last Name:GREGORY
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 1:3111 PETALUMA AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-4239
Mailing Address - Country:US
Mailing Address - Phone:310-489-1989
Mailing Address - Fax:
Practice Address - Street 1:2100 N SEPULVEDA BLVD
Practice Address - Street 2:#35
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2948
Practice Address - Country:US
Practice Address - Phone:310-954-2144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90473106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist