=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497483879
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHAWN THOMAS WEBB LPC, LCDC, NCC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2022
-----------------------------------------------------
Last Update Date | 08/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5900 MEMORIAL DR STE 218
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77007-8008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-478-0905
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3231 ALLEN PKWY APT 5104
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77019-1828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-478-0905
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 85293
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------