MEDICARE: SHANTA G ATKINSON LPC, LCDC

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	76524	TX

General Provider Information

NPI Number	:	1558983171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANTA G ATKINSON LPC, LCDC

Provider Business Mailing Address
First Line	:	7800 N SAM HOUSTON PKWY E APT 7202
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77396-4607
Country	:	US
Telephone Number	:	912-258-0013
Fax Number	:

Provider Business Practice Location Address
First Line	:	7800 N SAM HOUSTON PKWY E APT 7202
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77396-4607
Country	:	US
Telephone Number	:	912-258-0013
Fax Number	:

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

Provider Enumeration Date	:	05/18/2020
Last Update Date	:	05/18/2020

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