Provider Demographics
NPI:1295351633
Name:SHAWVER, LAUREN ELAINE
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELAINE
Last Name:SHAWVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 BRAZOS BLVD APT 2206
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-5462
Mailing Address - Country:US
Mailing Address - Phone:817-805-1112
Mailing Address - Fax:
Practice Address - Street 1:2801 BRAZOS BLVD APT 22062801
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-5435
Practice Address - Country:US
Practice Address - Phone:817-805-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
TX84333101YM0800X
TX101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health