Provider Demographics
NPI:1407401706
Name:SHEWCHUK, RYANNE (MS, NCC, LPC INTERN)
Entity Type:Individual
Prefix:
First Name:RYANNE
Middle Name:
Last Name:SHEWCHUK
Suffix:
Gender:F
Credentials:MS, NCC, LPC INTERN
Other - Prefix:
Other - First Name:NIKI
Other - Middle Name:
Other - Last Name:SHEWCHUK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5510 ABRAMS RD STE 118
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-2099
Mailing Address - Country:US
Mailing Address - Phone:214-208-7469
Mailing Address - Fax:
Practice Address - Street 1:5510 ABRAMS RD STE 118
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-2099
Practice Address - Country:US
Practice Address - Phone:214-208-7469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78587101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional