Provider Demographics
NPI:1427633072
Name:WASHINGTON, SHAKYRA MARIE (LPC ASSOCIATE)
Entity type:Individual
Prefix:
First Name:SHAKYRA
Middle Name:MARIE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 BALCONES DR STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4298
Mailing Address - Country:US
Mailing Address - Phone:328-416-1239
Mailing Address - Fax:
Practice Address - Street 1:12840 S KIRKWOOD RD APT 723
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-3834
Practice Address - Country:US
Practice Address - Phone:832-416-1239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2024-10-09
Deactivation Date:2024-09-20
Deactivation Code:
Reactivation Date:2024-10-08
Provider Licenses
StateLicense IDTaxonomies
TXRBT-21-159684106S00000X
TX96564101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician