Provider Demographics
NPI:1184650301
Name:MASHBURN, PATRICIA EVANS (MED, LPC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:EVANS
Last Name:MASHBURN
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2629 PLAZA PKWY
Mailing Address - Street 2:SUITE 19B
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-3885
Mailing Address - Country:US
Mailing Address - Phone:940-696-3042
Mailing Address - Fax:940-696-3043
Practice Address - Street 1:2629 PLAZA PKWY
Practice Address - Street 2:SUITE 19B
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-3885
Practice Address - Country:US
Practice Address - Phone:940-696-3042
Practice Address - Fax:940-696-3043
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11715101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2314LCOtherBC/BS IDENTIFIER