Provider Demographics
NPI:1154378727
Name:SEABOURN, SHANE LEE (MSW)
Entity type:Individual
Prefix:MR
First Name:SHANE
Middle Name:LEE
Last Name:SEABOURN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6651 SPARROWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OAKLANDON
Mailing Address - State:IN
Mailing Address - Zip Code:46236-8126
Mailing Address - Country:US
Mailing Address - Phone:918-961-2272
Mailing Address - Fax:
Practice Address - Street 1:5638 PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-5042
Practice Address - Country:US
Practice Address - Phone:317-247-8900
Practice Address - Fax:317-247-8935
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006606A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical