Provider Demographics
NPI:1750833570
Name:SHUCK, SARA (MS, LPC, LCDC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:SHUCK
Suffix:
Gender:F
Credentials:MS, LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 S. FM. 51 STE. 400 #105
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-2346
Mailing Address - Country:US
Mailing Address - Phone:940-220-8335
Mailing Address - Fax:940-612-6029
Practice Address - Street 1:2519 SCRIPTURE ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2324
Practice Address - Country:US
Practice Address - Phone:940-381-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-27
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73046101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor