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General NPI Number Information
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NPI Number | 1093230823
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Entity Type | Organization
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Legal Business Name | SHANAZ IKONNE, PLLC
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Dates
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Enumeration Date | 08/14/2017
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Last Update Date | 08/15/2017
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Provider Practice Location Address
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Address Line | 1021 RANCH ROAD 620 S STE B
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City | LAKEWAY
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State | TX
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Zip | 78734-5611
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Country | US
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Telephone | 469-626-9085
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Fax |
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Provider Business Mailing Address
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Address Line | 7500 S IH 35 UNIT 523
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City | AUSTIN
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State | TX
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Zip | 78745-6626
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Country | US
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Telephone | 469-626-9085
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHANAZ SARA IKONNE
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Credential | MA
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Telephone | 469-626-9085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 73271
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License Number State | TX
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