Provider Demographics
NPI:1104014539
Name:HISAW, SHANA (LPC-S)
Entity Type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:
Last Name:HISAW
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14646 COMPASS ST STE 10
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-6232
Mailing Address - Country:US
Mailing Address - Phone:361-852-0988
Mailing Address - Fax:
Practice Address - Street 1:14646 COMPASS ST STE 10
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-6232
Practice Address - Country:US
Practice Address - Phone:361-852-0988
Practice Address - Fax:361-687-2563
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61770101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional