Individual provider Active NPI

Kelly Duggan Shearer, LMFT

  • Marriage & Family Therapist
  • Glendora, CA
National Provider Identifier
1205273208
Registry record updated May 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
MFC45250 Issued in CA
Practice address
720 Caballo Ave
Glendora, CA 91740-4537
Phone
(626) 841-9165
NPI assigned
May 30, 2013
Last updated
May 30, 2013By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 30, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X MFC45250 CA Primary

Addresses

Primary practice location

720 Caballo Ave
Glendora, CA 91740-4537

Mailing address

PO Box 1703
Glendora, CA 91740-1703
Phone (626) 841-9165

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Jul 5, 2025 through Jul 5, 2027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
MFC45250CAMDMarriage & Family Therapist
45250CAMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1369872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369872000000",
    "number": "1205273208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1703",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917401703",
            "telephone_number": "626-841-9165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 CABALLO AVE",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917404537",
            "telephone_number": "626-841-9165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEARER",
        "first_name": "KELLY",
        "middle_name": "DUGGAN",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-05-30",
        "last_updated": "2013-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MFC45250",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendora, CA

Sources for this page

Verify at the official NPI Registry.