Basic Information
| Provider Information | |||||||||
| NPI: | 1841849908 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | SHUNNON | ||||||||
| MiddleName: | BULSHUN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.S., PPS, APCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 45111 FERN AVE | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935342301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619491206 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 45111 FERN AVE | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935342301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619491206 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2019 | ||||||||
| LastUpdateDate: | 09/23/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | APC6444 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.