Provider Demographics
NPI:1104259142
Name:SHOMAKER, KARAN KAY (LPC)
Entity type:Individual
Prefix:
First Name:KARAN
Middle Name:KAY
Last Name:SHOMAKER
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 1:6311 RUTGERS ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-6741
Mailing Address - Country:US
Mailing Address - Phone:806-420-9421
Mailing Address - Fax:
Practice Address - Street 1:3611 S SONCY RD
Practice Address - Street 2:SUITE 4A
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6480
Practice Address - Country:US
Practice Address - Phone:806-367-7938
Practice Address - Fax:806-355-6842
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68168101YM0800X, 101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX331453603Medicaid