Provider Demographics
NPI:1467618389
Name:SHAHAN, HEATHER (MS)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:SHAHAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 N RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76111-3911
Mailing Address - Country:US
Mailing Address - Phone:817-338-4471
Mailing Address - Fax:817-338-1811
Practice Address - Street 1:159 N RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76111-3911
Practice Address - Country:US
Practice Address - Phone:817-338-4471
Practice Address - Fax:817-338-1811
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62088101YM0800X
TX200933106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist