Basic Information
| Provider Information | |||||||||
| NPI: | 1962578419 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEDRANO | ||||||||
| FirstName: | SHANNON | ||||||||
| MiddleName: | PATRICE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LMFT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MELLO | ||||||||
| OtherFirstName: | SHANNON | ||||||||
| OtherMiddleName: | PATRICE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 18 COUNTY CENTER DR | ||||||||
| Address2: | |||||||||
| City: | OROVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959653335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305387705 | ||||||||
| FaxNumber: | 5305387852 | ||||||||
| Practice Location | |||||||||
| Address1: | 18 COUNTY CENTER DR | ||||||||
| Address2: | BUTTE CO DEPT OF BEHAVIORAL HEALTH | ||||||||
| City: | OROVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959653335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305387705 | ||||||||
| FaxNumber: | 5305387852 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2006 | ||||||||
| LastUpdateDate: | 03/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 45756 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.