Provider Demographics
NPI:1013195528
Name:INEZ, SHAWNEE (LCSW LISAC)
Entity Type:Individual
Prefix:
First Name:SHAWNEE
Middle Name:
Last Name:INEZ
Suffix:
Gender:F
Credentials:LCSW LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 N TUCSON BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-4745
Mailing Address - Country:US
Mailing Address - Phone:520-465-1836
Mailing Address - Fax:520-690-5754
Practice Address - Street 1:430 N TUCSON BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-4745
Practice Address - Country:US
Practice Address - Phone:520-465-1836
Practice Address - Fax:520-690-5754
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW116561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical