Provider Demographics
NPI:1316834401
Name:SHUTTLEWORTH, EDWARD VAN HEUSEN (MA, AMFT)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:VAN HEUSEN
Last Name:SHUTTLEWORTH
Suffix:
Gender:M
Credentials:MA, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 STANDARD ST
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-3038
Mailing Address - Country:US
Mailing Address - Phone:917-558-5953
Mailing Address - Fax:
Practice Address - Street 1:435 STANDARD ST
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-3038
Practice Address - Country:US
Practice Address - Phone:917-558-5953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA152193106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist