Provider Demographics
NPI:1104294388
Name:STONE, SHAUN ADRIEL (MA, LPC-INTERN)
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:ADRIEL
Last Name:STONE
Suffix:
Gender:M
Credentials:MA, LPC-INTERN
Other - Prefix:
Other - First Name:SHAUN
Other - Middle Name:ADRIEL
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC-INTERN
Mailing Address - Street 1:11327 ENCHANTED SUNSET ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-5007
Mailing Address - Country:US
Mailing Address - Phone:210-557-2575
Mailing Address - Fax:
Practice Address - Street 1:11327 ENCHANTED SUNSET ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-5007
Practice Address - Country:US
Practice Address - Phone:210-557-2575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73918101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health