Provider Demographics
NPI:1881302529
Name:AVERY, SHANA KAE (LMFT-A)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:KAE
Last Name:AVERY
Suffix:
Gender:F
Credentials:LMFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 505
Mailing Address - Street 2:
Mailing Address - City:MUENSTER
Mailing Address - State:TX
Mailing Address - Zip Code:76252-0505
Mailing Address - Country:US
Mailing Address - Phone:512-750-9407
Mailing Address - Fax:
Practice Address - Street 1:1420 TWIN OAKS ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76302-2723
Practice Address - Country:US
Practice Address - Phone:940-696-0181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204665101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health