Individual
SHAWN PATRICK POWERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2178 JOHNSON AVE, SAN LUIS OBISPO, CA 93401-4535
(805) 440-1031
Mailing address
2178 JOHNSON AVE, SAN LUIS OBISPO, CA 93401
(805) 440-1031
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
38253
CA
Other
Enumeration date
04/19/2017
Last updated
04/19/2017
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