Provider Demographics
NPI:1790851038
Name:COTTON, SHANELLE MARIE
Entity type:Individual
Prefix:
First Name:SHANELLE
Middle Name:MARIE
Last Name:COTTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANE
Other - Middle Name:MARIE
Other - Last Name:COTTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:300 BRADFORD ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1530
Mailing Address - Country:US
Mailing Address - Phone:650-363-4000
Mailing Address - Fax:
Practice Address - Street 1:300 BRADFORD ST
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1530
Practice Address - Country:US
Practice Address - Phone:650-363-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2025-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA152061106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4142OtherSANTA CLARA COUNTYID#
CA152061OtherLMFT