Provider Demographics
NPI:1326865833
Name:LONEY, SHEVAUGHN MARCELLA (EDS)
Entity type:Individual
Prefix:
First Name:SHEVAUGHN
Middle Name:MARCELLA
Last Name:LONEY
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 W MERIDIAN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-2913
Mailing Address - Country:US
Mailing Address - Phone:317-789-4175
Mailing Address - Fax:317-865-2710
Practice Address - Street 1:202 W MERIDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46217-2913
Practice Address - Country:US
Practice Address - Phone:317-789-4175
Practice Address - Fax:317-865-2710
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10292853103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool