Provider Demographics
NPI:1124526710
Name:MCKOWN, SHAWN (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:
Last Name:MCKOWN
Suffix:
Gender:F
Credentials:PSYD
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 1452
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-1452
Mailing Address - Country:US
Mailing Address - Phone:210-833-4788
Mailing Address - Fax:
Practice Address - Street 1:24123 BOERNE STAGE RD STE 430
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78255-9409
Practice Address - Country:US
Practice Address - Phone:210-833-4788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24928103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical