Provider Demographics
NPI:1962578419
Name:MEDRANO, SHANNON PATRICE (LMFT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:PATRICE
Last Name:MEDRANO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:PATRICE
Other - Last Name:MELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18 COUNTY CENTER DR
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-3335
Mailing Address - Country:US
Mailing Address - Phone:530-538-7705
Mailing Address - Fax:530-538-7852
Practice Address - Street 1:18 COUNTY CENTER DR
Practice Address - Street 2:BUTTE CO DEPT OF BEHAVIORAL HEALTH
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-3335
Practice Address - Country:US
Practice Address - Phone:530-538-7705
Practice Address - Fax:530-538-7852
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45756106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist