Provider Demographics
NPI:1194149336
Name:SHEADE, HALLIE (PHD, LPC-S, RPT-S)
Entity type:Individual
Prefix:DR
First Name:HALLIE
Middle Name:
Last Name:SHEADE
Suffix:
Gender:F
Credentials:PHD, LPC-S, RPT-S
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 122692
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76121-2692
Mailing Address - Country:US
Mailing Address - Phone:682-334-3784
Mailing Address - Fax:
Practice Address - Street 1:16151 HIGHWAY 377 S
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76126-5544
Practice Address - Country:US
Practice Address - Phone:682-334-3784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-07
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67848101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional