Provider Demographics
NPI:1285326652
Name:ELLIS, SHAUNA (LCSW-S)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LCSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SURREY LN APT 201
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-4187
Mailing Address - Country:US
Mailing Address - Phone:817-602-1084
Mailing Address - Fax:
Practice Address - Street 1:3312 TEASLEY LN STE 100
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-8311
Practice Address - Country:US
Practice Address - Phone:940-222-2399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical