Provider Demographics
NPI:1174758122
Name:SHUKEN, GISELLE ELYSE (MA)
Entity type:Individual
Prefix:MISS
First Name:GISELLE
Middle Name:ELYSE
Last Name:SHUKEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15340 DEVONSHIRE ST STE 7
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-2760
Mailing Address - Country:US
Mailing Address - Phone:805-405-0445
Mailing Address - Fax:
Practice Address - Street 1:15340 DEVONSHIRE ST STE 7
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-2760
Practice Address - Country:US
Practice Address - Phone:805-405-0445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99198106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA99198OtherLICENSED MARRIAGE AND FAMILY THERAPIST