Individual
ANTONIO SHALLOWHORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
510 S VERMONT AVE, LOS ANGELES, CA 90020-1912
(424) 429-2767
Mailing address
3711 LONG BEACH BLVD STE 4057, LONG BEACH, CA 90807-3320
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
105201
CA
1041C0700X
Clinical Social Worker
Primary
105201
CA
1041C0700X
Clinical Social Worker
Primary
137739
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/11/2019
Last updated
04/17/2026
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