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General NPI Number Information
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NPI Number | 1194149336
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Entity Type | Individual
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Provider Name | HALLIE SHEADE PHD, LPC-S, RPT-S
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Gender | Female
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Dates
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Enumeration Date | 02/07/2014
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Last Update Date | 01/13/2022
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Provider Practice Location Address
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Address Line | 16151 HIGHWAY 377 S
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City | FORT WORTH
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State | TX
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Zip | 76126-5544
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Country | US
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Telephone | 682-334-3784
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 122692
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City | FORT WORTH
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State | TX
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Zip | 76121-2692
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Country | US
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Telephone | 682-334-3784
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 67848
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License Number State | TX
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