Provider Demographics
NPI:1720337884
Name:BEGAY, SHAULA (MC, LPCC, NCC)
Entity Type:Individual
Prefix:
First Name:SHAULA
Middle Name:
Last Name:BEGAY
Suffix:
Gender:F
Credentials:MC, LPCC, NCC
Other - Prefix:
Other - First Name:SHAULA
Other - Middle Name:
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1996
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87499-1996
Mailing Address - Country:US
Mailing Address - Phone:505-497-0946
Mailing Address - Fax:
Practice Address - Street 1:3300 N BUTLER AVE STE 202
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-2362
Practice Address - Country:US
Practice Address - Phone:505-497-0946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0175971101YM0800X
NM0150281101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM14833310Medicaid
NM00078336Medicaid