MEDICARE: SHAWN BURCH LPC

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	101YM0800X	Mental Health Counselor	15542	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3941LC	OTHER	TX	BCBS ID

General Provider Information

NPI Number	:	1306061486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN BURCH LPC

Provider Business Mailing Address
First Line	:	13011 RIVER RD
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78132-2117
Country	:	US
Telephone Number	:	830-964-4054
Fax Number	:	830-964-4227

Provider Business Practice Location Address
First Line	:	1175 FM 2673 STE 15
Second Line	:
City	:	CANYON LAKE
State	:	TX
Zip	:	78133-4514
Country	:	US
Telephone Number	:	830-964-4054
Fax Number	:

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

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	07/08/2007

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