Provider Demographics
NPI:1447479019
Name:SHINER, AMY (MC)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:SHINER
Suffix:
Gender:F
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 E CAMPBELL TER
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5951
Mailing Address - Country:US
Mailing Address - Phone:520-297-8820
Mailing Address - Fax:
Practice Address - Street 1:5956 E PIMA ST
Practice Address - Street 2:SUITE 130
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4375
Practice Address - Country:US
Practice Address - Phone:520-297-8820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 12234101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional