Provider Demographics
NPI:1902258924
Name:HOLDER, SHAUNA (M ED, LPC)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:HOLDER
Suffix:
Gender:F
Credentials:M ED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 E MOCKINGBIRD LN STE 275
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-2189
Mailing Address - Country:US
Mailing Address - Phone:361-575-4351
Mailing Address - Fax:
Practice Address - Street 1:1501 E MOCKINGBIRD LN STE 275
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-2189
Practice Address - Country:US
Practice Address - Phone:361-575-4351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-01
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83206101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional