Provider Demographics
NPI:1376300657
Name:CRISP, SHAYNA D (LPC)
Entity Type:Individual
Prefix:
First Name:SHAYNA
Middle Name:D
Last Name:CRISP
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 ROCKLEDGE CT
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-1560
Mailing Address - Country:US
Mailing Address - Phone:682-553-6435
Mailing Address - Fax:
Practice Address - Street 1:604 ROCKLEDGE CT
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:TX
Practice Address - Zip Code:76008-1560
Practice Address - Country:US
Practice Address - Phone:682-553-6435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65568101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional