Provider Demographics
NPI:1417235763
Name:SHOPE, JAN COLLINS (LPC)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:COLLINS
Last Name:SHOPE
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 1:311 RR 620 S STE 106
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-4747
Mailing Address - Country:US
Mailing Address - Phone:512-263-4200
Mailing Address - Fax:512-263-4200
Practice Address - Street 1:311 RR 620 S STE 106
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-4747
Practice Address - Country:US
Practice Address - Phone:512-263-4200
Practice Address - Fax:512-263-4200
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18652101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional