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Shellie Lee Revilla

Marriage & Family Therapist in Campbell, CA. Individual provider (NPI-1).

NPI number1699409482
StatusActive
Last updated in NPPESJul 15, 2022

Details

NPI
1699409482
Entity type
Individual (NPI-1)
Name
Shellie Lee Revilla
Sex
Female
Sole proprietor
Yes
Enumeration date
Jul 15, 2022
Certification date
Jul 15, 2022
Last updated
Jul 15, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
106H00000X Marriage & Family TherapistMFT35689CAYes

Practice location

4916 Poplar Ter
Campbell, CA 95008-5717

Phone 408-202-3992

Mailing address

4916 Poplar Ter
Campbell, CA 95008-5717

Phone 408-202-3992

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