Provider Demographics
NPI:1417216011
Name:COWIN, SHAYNA (LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:SHAYNA
Middle Name:
Last Name:COWIN
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:683 BONHAM DR
Mailing Address - Street 2:
Mailing Address - City:LAVON
Mailing Address - State:TX
Mailing Address - Zip Code:75166-1764
Mailing Address - Country:US
Mailing Address - Phone:972-743-5674
Mailing Address - Fax:
Practice Address - Street 1:14114 DALLAS PKWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-4325
Practice Address - Country:US
Practice Address - Phone:972-743-5674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10886101YA0400X
TX66727101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)