| Doctor Name: | MR. KEVIN EDWARD SHIELDS |
| NPI Number: | 1427186253 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 162 E Carson St Ste A Colusa, CA - 959322866 |
| Business Phone Number: | 5304580524 |
| Business Fax Number: | 5304587751 |
| Mailing Address: | 162 E Carson St. Suite A, COLUSA |
| State: | CA |
| Postal Code: | 95932 |
| Phone Number: | 5304580524 |
| Fax Number: | 5304587751 |
| NPI Enumeration Date: | 03/01/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |