Individual
MRS. CAROLYN NMN SHIVELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2178 JOHNSON AVE, SAN LUIS OBISPO, CA 93401-4535
(805) 781-4738
(805) 781-1232
Mailing address
461 YERBA BUENA ST, MORRO BAY, CA 93442-2973
(805) 772-6992
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
13693
CA
Other
Enumeration date
12/04/2006
Last updated
07/08/2007
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