Provider Demographics
NPI:1881256956
Name:CHESLEY-KROH, SHAWNA RENEE (MC, LPC)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:RENEE
Last Name:CHESLEY-KROH
Suffix:
Gender:F
Credentials:MC, LPC
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:
Other - Last Name:KROH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MC, LPC
Mailing Address - Street 1:8493 N SPRING CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85742-4842
Mailing Address - Country:US
Mailing Address - Phone:520-401-6674
Mailing Address - Fax:
Practice Address - Street 1:7445 N ORACLE RD STE 155
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-6586
Practice Address - Country:US
Practice Address - Phone:520-791-9974
Practice Address - Fax:520-791-0676
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-17968101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPC-17968OtherPRIVATE PRACTICE