MEDICARE: KRISTIN SHANAHAN 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	101YP2500X	Professional Counselor	67338	TX

General Provider Information

NPI Number	:	1609215862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN SHANAHAN LPC

Provider Business Mailing Address
First Line	:	1211 BAYLOR ST
Second Line	:	SUITE 200
City	:	AUSTIN
State	:	TX
Zip	:	78703-4104
Country	:	US
Telephone Number	:	512-413-5373
Fax Number	:	512-280-4130

Provider Business Practice Location Address
First Line	:	1211 BAYLOR ST
Second Line	:	SUITE 200
City	:	AUSTIN
State	:	TX
Zip	:	78703-4104
Country	:	US
Telephone Number	:	512-413-5373
Fax Number	:	512-280-4130

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

Provider Enumeration Date	:	06/21/2013
Last Update Date	:	06/21/2013

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