MEDICARE: SHOCKNEY AND ASSOCIATES, INC.

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	101YP2500X	Professional Counselor	3070	CO

General Provider Information

NPI Number	:	1457539637
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHOCKNEY AND ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	1115 ELKTON DR
Second Line	:	SUITE 107
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-8507
Country	:	US
Telephone Number	:	719-577-9958
Fax Number	:	719-473-5893

Provider Business Practice Location Address
First Line	:	1115 ELKTON DR
Second Line	:	SUITE 107
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-8507
Country	:	US
Telephone Number	:	719-577-9958
Fax Number	:	719-473-5893

Authorized Official
Title or Position	:	CEO
Name	:	DR. EDWIN ALLEN SHOCKNEY
Credential	:	PHD LPC
Telephone Number	:	719-577-9958

Provider Enumeration Date	:	02/10/2008
Last Update Date	:	02/10/2008

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