Provider Demographics
NPI:1447649041
Name:STOREY-LOVIN, SHAWNA (LPC)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:STOREY-LOVIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 132
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-0132
Mailing Address - Country:US
Mailing Address - Phone:512-937-2377
Mailing Address - Fax:
Practice Address - Street 1:4100 EVERETT DR
Practice Address - Street 2:SUITE 200
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6146
Practice Address - Country:US
Practice Address - Phone:512-268-2768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65651101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional