Courtney Shen Deshetler, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

31253 Issued in CA

Practice address

232 W Main St Ste 103
Tustin, CA 92780-7712

Phone

(714) 462-3108

NPI assigned

Oct 21, 2019

Reactivated

Feb 23, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Courtney Anne Shen Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Courtney Shen Psychology, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Tustin, CA
  • NPI 1306478375
  NPD Authorized official

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

{
    "created_epoch": "1571616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717372800000",
    "number": "1972146108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3419 E CHAPMAN AVE # 354",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928693812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "232 W MAIN ST STE 103",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927807712",
            "telephone_number": "714-462-3108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESHETLER",
        "first_name": "COURTNEY",
        "middle_name": "SHEN",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-21",
        "last_updated": "2024-06-03",
        "certification_date": "2024-06-03",
        "deactivation_date": "2019-10-22",
        "reactivation_date": "2022-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "31253",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COURTNEY",
            "last_name": "SHEN",
            "middle_name": "ANNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Clinical Psychologist in Tustin, CA
• Providers in Tustin, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.