Provider Demographics
NPI:1316271844
Name:SHOCKNEY, EDWIN ALLEN (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:ALLEN
Last Name:SHOCKNEY
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 ELKTON DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-8507
Mailing Address - Country:US
Mailing Address - Phone:719-577-9958
Mailing Address - Fax:719-473-5893
Practice Address - Street 1:1115 ELKTON DR
Practice Address - Street 2:SUITE 107
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8507
Practice Address - Country:US
Practice Address - Phone:719-577-9958
Practice Address - Fax:719-473-5893
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3070101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional