Provider Demographics
NPI:1336849017
Name:SHIN, EDWARD LAWRENCE JOONG II (AMFT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:LAWRENCE JOONG
Last Name:SHIN
Suffix:II
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1538 S 175 E
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-7694
Mailing Address - Country:US
Mailing Address - Phone:949-295-3964
Mailing Address - Fax:
Practice Address - Street 1:485 W 1400 N STE 10
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-7000
Practice Address - Country:US
Practice Address - Phone:801-438-4045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12675017-3904101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health