Provider Demographics
NPI:1457498271
Name:EDGINGTON, SHAWN C (PHD)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:C
Last Name:EDGINGTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3651 N 100 E STE 100
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-4598
Mailing Address - Country:US
Mailing Address - Phone:801-356-0014
Mailing Address - Fax:801-373-3655
Practice Address - Street 1:3651 N 100 E STE 100
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-4598
Practice Address - Country:US
Practice Address - Phone:801-356-0014
Practice Address - Fax:801-373-3655
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT317666-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional