Provider Demographics
NPI:1669682258
Name:ORTIZ, SHAWNE STACIE (PSYD, LPC-S)
Entity Type:Individual
Prefix:MISS
First Name:SHAWNE
Middle Name:STACIE
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:PSYD, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2556 HUNT ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-2998
Mailing Address - Country:US
Mailing Address - Phone:210-685-1529
Mailing Address - Fax:866-556-8569
Practice Address - Street 1:2556 HUNT ST
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-2998
Practice Address - Country:US
Practice Address - Phone:210-685-1529
Practice Address - Fax:866-556-8569
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61423101YP2500X, 101Y00000X
TX34976103TM1800X
TX36936103TC1900X
TX39042104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179138601Medicaid
TX179138602Medicaid