Provider Demographics
NPI:1164100251
Name:SHUTTLEWORTH, ALEJANDRA JUAREZ
Entity type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:JUAREZ
Last Name:SHUTTLEWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEJANDRA
Other - Middle Name:
Other - Last Name:JUAREZ-SHUTTLEWORTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:77 SOLANO SQ # 208
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-2712
Mailing Address - Country:US
Mailing Address - Phone:415-410-1005
Mailing Address - Fax:
Practice Address - Street 1:3450 3RD ST STE 1C
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-1444
Practice Address - Country:US
Practice Address - Phone:415-437-3990
Practice Address - Fax:415-437-3994
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT148834106H00000X
CA101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional