Provider Demographics
NPI:1811640717
Name:HOGAN, SHELLY LYNN (LMFT)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:LYNN
Last Name:HOGAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8805 JESSE JAMES DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-6366
Mailing Address - Country:US
Mailing Address - Phone:512-799-1009
Mailing Address - Fax:
Practice Address - Street 1:2110 W SLAUGHTER LN
Practice Address - Street 2:SUITE 107 NUMBER 645
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748
Practice Address - Country:US
Practice Address - Phone:512-799-1009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203337101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health