Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | PSB 94022177 | CA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSB 94022177 | CA |
N | 103TA0700X | Adult Development & Aging Psychologist | PSB 94022177 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSB 94022177 | CA |
Y | 103G00000X | Clinical Psychologist | PSB 94022177 | CA |
Y | 103TC0700X | Clinical Psychologist | PSB 94022177 | CA |
N | 103TC1900X | Counseling Psychologist | PSB 94022177 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSB 94022177 | CA |
N | 103TF0000X | Family Psychologist | PSB 94022177 | CA |
N | 103TP2701X | Group Psychotherapist | PSB 94022177 | CA |
NPI | 1518311232 |
---|---|
Provider Name | Lyndi Elizabeth Shaw |
First Address | Sacramento, CA 95816-4311 |
Second Address | Sacramento, CA 95816-4311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2016 |
Last Update Date | 19/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PSB 94022177 | BOARD OF PSYCHOLOGY (01) | CA |