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Individual
MS. SHAUNA LEIGH KETCHAM
Active
Individual
MS. SHAUNA LEIGH KETCHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ASW
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
79168
CA
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
79168
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1871855916
OUT- PATIENT MENTAL HEATH CENTER
CA
Enumeration date
01/24/2018
Last updated
01/24/2018
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