Provider Demographics
NPI:1609215862
Name:SHANAHAN, KRISTIN (LPC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:SHANAHAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1211 BAYLOR ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4104
Mailing Address - Country:US
Mailing Address - Phone:512-413-5373
Mailing Address - Fax:512-280-4130
Practice Address - Street 1:1211 BAYLOR ST
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4104
Practice Address - Country:US
Practice Address - Phone:512-413-5373
Practice Address - Fax:512-280-4130
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67338101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional