Provider Demographics
NPI:1679232185
Name:MCGUIRE, SHAUN M
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:M
Last Name:MCGUIRE
Suffix:
Gender:M
Credentials:
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 62166
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80962-2166
Mailing Address - Country:US
Mailing Address - Phone:719-500-1599
Mailing Address - Fax:
Practice Address - Street 1:6455 N UNION BLVD STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-5844
Practice Address - Country:US
Practice Address - Phone:719-500-1599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-12
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0019089101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional