Provider Demographics
NPI:1659602753
Name:HAYWOOD, SHIRLEY D (MED, LCPC)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:D
Last Name:HAYWOOD
Suffix:
Gender:F
Credentials:MED, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 MANCHACA RD
Mailing Address - Street 2:BLDG 1, SUITE 103
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748
Mailing Address - Country:US
Mailing Address - Phone:512-906-8311
Mailing Address - Fax:512-474-1839
Practice Address - Street 1:8700 MANCHACA RD
Practice Address - Street 2:BLDG 1, SUITE 103
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748
Practice Address - Country:US
Practice Address - Phone:512-906-8311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0663101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor