| Doctor Name: | MARIAROSE M SHANAHE |
| NPI Number: | 1326151895 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | L4547 |
| Business Practice Address: | 1010 1st St Se Suite 265 Bandon, OR - 974119301 |
| Business Phone Number: | 5413290110 |
| Business Fax Number: | |
| Mailing Address: | 1010 1st St Se, Suite 265 BANDON |
| State: | OR |
| Postal Code: | 974119301 |
| Phone Number: | 5413290110 |
| Fax Number: | |
| NPI Enumeration Date: | 08/17/2006 |
| NPI Last Update Date: | 12/07/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | L4547 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |