Provider Demographics
NPI:1144568817
Name:MAURIN, CAROLYN SHANNON (LPC)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:SHANNON
Last Name:MAURIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:SHANNON
Other - Last Name:MAURIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:10817 TRAIL WEARY DRIVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754
Mailing Address - Country:US
Mailing Address - Phone:512-925-0883
Mailing Address - Fax:
Practice Address - Street 1:7703 N LAMAR BLVD
Practice Address - Street 2:SUITE 247
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-1027
Practice Address - Country:US
Practice Address - Phone:512-925-0883
Practice Address - Fax:844-270-2952
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67542101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional