Provider Demographics
NPI:1952601064
Name:SHEN, MARK (MC, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SHEN
Suffix:
Gender:M
Credentials:MC, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 E WARNER RD STE 2
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-4500
Mailing Address - Country:US
Mailing Address - Phone:602-510-2711
Mailing Address - Fax:
Practice Address - Street 1:1615 E WARNER RD STE 2
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-4500
Practice Address - Country:US
Practice Address - Phone:602-510-2711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-13507101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional