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General NPI Number Information
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NPI Number | 1619609906
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Entity Type | Individual
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Provider Name | SHAWNDA ELAINE WEAR LPC
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Gender | Female
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Dates
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Enumeration Date | 06/27/2022
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 2408 S 51ST CT STE G
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City | FORT SMITH
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State | AR
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Zip | 72903-3666
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Country | US
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Telephone | 479-323-2424
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Fax |
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Provider Business Mailing Address
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Address Line | 1210 MABLE NELL RD
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City | VAN BUREN
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State | AR
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Zip | 72956-2964
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Country | US
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Telephone | 479-806-3237
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | P2501017
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License Number State | AR
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