Provider Demographics
NPI:1851436976
Name:STUART-MAVER, SHANNON LEIGH
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:LEIGH
Last Name:STUART-MAVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:LEIGH
Other - Last Name:STUART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95518-0010
Mailing Address - Country:US
Mailing Address - Phone:707-840-4668
Mailing Address - Fax:
Practice Address - Street 1:1977 LESLIE CT
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-4754
Practice Address - Country:US
Practice Address - Phone:707-840-4668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC1154101YM0800X
CA34386103TC0700X
CAMFC 46239106H00000X
OR3655103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist