Healthcare Provider Details

I. General information

NPI: 1215040696
Provider Name (Legal Business Name): SHAWN RENE' POGUE MA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 S WALNUT ST SUITE 215
SEYMOUR IN
47274-2991
US

IV. Provider business mailing address

415 S WALNUT ST SUITE 215
SEYMOUR IN
47274-2991
US

V. Phone/Fax

Practice location:
  • Phone: 812-523-0386
  • Fax: 812-523-8416
Mailing address:
  • Phone: 812-523-0386
  • Fax: 812-523-8416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC-0005971
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number39001308A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberC-0005971
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC-0005971
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: