Provider Demographics
NPI:1891821112
Name:DOTY, SHANNON CHRISTINE (LMFT)
Entity type:Individual
Prefix:MISS
First Name:SHANNON
Middle Name:CHRISTINE
Last Name:DOTY
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 1:1618 S BREEZY MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-2497
Mailing Address - Country:US
Mailing Address - Phone:408-318-0112
Mailing Address - Fax:
Practice Address - Street 1:1618 S BREEZY MEADOW DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-2497
Practice Address - Country:US
Practice Address - Phone:855-936-8423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA44926106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist