Provider Demographics
NPI:1376051052
Name:MONROE, MICHAEL SHANE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:SHANE
Last Name:MONROE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8532 PEDERNALES TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76118-7486
Mailing Address - Country:US
Mailing Address - Phone:469-452-9168
Mailing Address - Fax:
Practice Address - Street 1:612 E LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-4121
Practice Address - Country:US
Practice Address - Phone:469-452-9168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX543981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical