Provider Demographics
NPI:1972317683
Name:SCRUGGS, SHAMONICA (LPC, LVN)
Entity type:Individual
Prefix:
First Name:SHAMONICA
Middle Name:
Last Name:SCRUGGS
Suffix:
Gender:F
Credentials:LPC, LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 LINDSEY LN
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-5675
Mailing Address - Country:US
Mailing Address - Phone:318-461-9972
Mailing Address - Fax:
Practice Address - Street 1:1105 KURTH DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-1945
Practice Address - Country:US
Practice Address - Phone:936-632-2450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX224P00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist