Provider Demographics
NPI:1851912562
Name:MACK-MORRIS, SHAWNA (LAC)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:MACK-MORRIS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15225 W GEORGIA DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-8184
Mailing Address - Country:US
Mailing Address - Phone:623-521-6947
Mailing Address - Fax:
Practice Address - Street 1:13460 N 94TH DR STE M1
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4247
Practice Address - Country:US
Practice Address - Phone:623-974-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor