Provider Demographics
NPI:1306061486
Name:BURCH, SHAWN (LPC)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:BURCH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SHAWN
Other - Middle Name:
Other - Last Name:DUBOIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:13011 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-2117
Mailing Address - Country:US
Mailing Address - Phone:830-964-4054
Mailing Address - Fax:830-964-4227
Practice Address - Street 1:1175 FM 2673 STE 15
Practice Address - Street 2:
Practice Address - City:CANYON LAKE
Practice Address - State:TX
Practice Address - Zip Code:78133-4514
Practice Address - Country:US
Practice Address - Phone:830-964-4054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15542101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3941LCOtherBCBS ID