Provider Demographics
NPI:1124504766
Name:EDGINGTON, SHAWN MARIE (LPC, LCDC)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:MARIE
Last Name:EDGINGTON
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:SHAWN
Other - Middle Name:MARIE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:175 WHISPER VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-8628
Mailing Address - Country:US
Mailing Address - Phone:830-285-4538
Mailing Address - Fax:
Practice Address - Street 1:1011 3RD ST
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-3651
Practice Address - Country:US
Practice Address - Phone:830-285-4538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76508101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional