Provider Demographics
NPI:1871912949
Name:SHANKS, VINCENT (PSYM, PSYD, PHD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:
Last Name:SHANKS
Suffix:
Gender:M
Credentials:PSYM, PSYD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44415 KINGSTON DR
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-5621
Mailing Address - Country:US
Mailing Address - Phone:951-265-0809
Mailing Address - Fax:951-302-2038
Practice Address - Street 1:44415 KINGSTON DR
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-5621
Practice Address - Country:US
Practice Address - Phone:951-265-0809
Practice Address - Fax:951-302-2038
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional