Provider Demographics
NPI:1417242165
Name:SUTCLIFFE, SHANA (LPC)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:SUTCLIFFE
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 1:2217 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-4216
Mailing Address - Country:US
Mailing Address - Phone:281-997-5400
Mailing Address - Fax:281-997-8408
Practice Address - Street 1:2217 PARK AVE
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-4216
Practice Address - Country:US
Practice Address - Phone:281-997-5400
Practice Address - Fax:281-997-8408
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64737101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health