Provider Demographics
NPI:1891350583
Name:SHANEY, SARAH ALEXIS LAURIELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ALEXIS LAURIELLE
Last Name:SHANEY
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 1:2217 JASMINE PATH
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-7148
Mailing Address - Country:US
Mailing Address - Phone:512-300-6645
Mailing Address - Fax:
Practice Address - Street 1:825 W 11TH ST STE C
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-2052
Practice Address - Country:US
Practice Address - Phone:210-960-5129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX596801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX59680OtherTEXAS DEPARTMENT OF STATE HEALTH SERVICES LICENSING BOARD