MEDICARE: SHAWN ELLEN CAUSBY LCMHC, LCAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCAS-21885	NC
2	101YP2500X	Professional Counselor	13293	NC
3	101YP2500X	Professional Counselor	A13293	NC
4	101YM0800X	Mental Health Counselor	13293	NC

General Provider Information

NPI Number	:	1235658063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN ELLEN CAUSBY LCMHC, LCAS

Provider Business Mailing Address
First Line	:	PO BOX 3112
Second Line	:
City	:	MATTHEWS
State	:	NC
Zip	:	28106-3112
Country	:	US
Telephone Number	:	210-607-0631
Fax Number	:

Provider Business Practice Location Address
First Line	:	5923 WAXHAW HWY
Second Line	:
City	:	MINERAL SPRINGS
State	:	NC
Zip	:	28108
Country	:	US
Telephone Number	:	210-607-0631
Fax Number	:	210-607-0631

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2017
Last Update Date	:	08/25/2025

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