Provider Demographics
NPI:1053062158
Name:PATTILLO, SHAYLA (MED, LPC)
Entity Type:Individual
Prefix:
First Name:SHAYLA
Middle Name:
Last Name:PATTILLO
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:SHAYLA
Other - Middle Name:
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED LPC
Mailing Address - Street 1:4319 ATTRA ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-4900
Mailing Address - Country:US
Mailing Address - Phone:512-435-1875
Mailing Address - Fax:
Practice Address - Street 1:4319 ATTRA ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-4900
Practice Address - Country:US
Practice Address - Phone:512-435-1875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68539101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional