Provider Demographics
NPI:1497293880
Name:BACKS, SHAWN PAUL (MA, LPC)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:PAUL
Last Name:BACKS
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 S 4TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-3067
Mailing Address - Country:US
Mailing Address - Phone:928-783-3986
Mailing Address - Fax:
Practice Address - Street 1:2749 W COUNTY 14TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-9757
Practice Address - Country:US
Practice Address - Phone:928-985-1186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 16512101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health