Provider Demographics
NPI:1679633903
Name:MCQUEEN, SHANNA JEANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:JEANNE
Last Name:MCQUEEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4214 50TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-3864
Mailing Address - Country:US
Mailing Address - Phone:806-771-1818
Mailing Address - Fax:806-748-2578
Practice Address - Street 1:4214 50TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-3864
Practice Address - Country:US
Practice Address - Phone:806-771-1818
Practice Address - Fax:806-748-2578
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX382061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical