Provider Demographics
NPI:1104086412
Name:CRIM, SHAUNA G (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHAUNA
Middle Name:G
Last Name:CRIM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:SHAUNA
Other - Middle Name:
Other - Last Name:SPERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:11016 EDWARD STREET
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046
Mailing Address - Country:US
Mailing Address - Phone:937-430-1025
Mailing Address - Fax:
Practice Address - Street 1:2501 CAPEHART RD
Practice Address - Street 2:
Practice Address - City:OFFUTT AFB
Practice Address - State:NE
Practice Address - Zip Code:68113-1043
Practice Address - Country:US
Practice Address - Phone:402-294-2362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1056103TC0700X, 103TC0700X
OH6558103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical