Provider Demographics
NPI:1568298172
Name:SHRUM, JOHN KEVIN (LPC-A)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:KEVIN
Last Name:SHRUM
Suffix:
Gender:M
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5899 PRESTON RD STE 1201
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-9594
Mailing Address - Country:US
Mailing Address - Phone:469-907-4683
Mailing Address - Fax:
Practice Address - Street 1:5899 PRESTON RD STE 1201
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-9594
Practice Address - Country:US
Practice Address - Phone:469-907-4683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95869101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health