Provider Demographics
NPI:1801257217
Name:SHEA, DANIEL (PSYD, LPC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:SHEA
Suffix:
Gender:M
Credentials:PSYD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 SHILOH RD
Mailing Address - Street 2:SUITE 1301
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-2426
Mailing Address - Country:US
Mailing Address - Phone:903-980-8622
Mailing Address - Fax:
Practice Address - Street 1:1820 SHILOH RD
Practice Address - Street 2:SUITE 1301
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-2426
Practice Address - Country:US
Practice Address - Phone:903-980-8622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16207101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional