Provider Demographics
NPI:1578808101
Name:EILDERS, SHAUN T (LPC)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:T
Last Name:EILDERS
Suffix:
Gender:M
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:PO BOX 162
Mailing Address - Street 2:
Mailing Address - City:HAHIRA
Mailing Address - State:GA
Mailing Address - Zip Code:31632-0162
Mailing Address - Country:US
Mailing Address - Phone:229-560-2692
Mailing Address - Fax:229-794-0079
Practice Address - Street 1:5671 BOYS RANCH RD
Practice Address - Street 2:
Practice Address - City:HAHIRA
Practice Address - State:GA
Practice Address - Zip Code:31632-2582
Practice Address - Country:US
Practice Address - Phone:229-560-2692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-08
Last Update Date:2012-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003677101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health