Basic Information
| Provider Information | |||||||||
| NPI: | 1316074487 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILSON-MCGEE | ||||||||
| FirstName: | SHANTEL | ||||||||
| MiddleName: | JONQUEL | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 151 W FORHAN ST | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908052119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624280078 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1303 W WALNUT PKWY | ||||||||
| Address2: | |||||||||
| City: | COMPTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902205030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622089492 | ||||||||
| FaxNumber: | 3108685398 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 03/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 101395 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YM0800X | IMF88785 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.