Provider Demographics
NPI:1790163608
Name:FURNACE, SHANA LYNN (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:SHANA
Middle Name:LYNN
Last Name:FURNACE
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 1:1806 CLOVIS DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-4281
Mailing Address - Country:US
Mailing Address - Phone:210-852-1365
Mailing Address - Fax:
Practice Address - Street 1:1750 PRESIDENTS ST
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5617
Practice Address - Country:US
Practice Address - Phone:571-526-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0094831041C0700X
TX649451041C0700X
FLSW164581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical