Provider Demographics
NPI:1013771583
Name:ADDISON, PERRIN SHALEA (LPC)
Entity type:Individual
Prefix:
First Name:PERRIN
Middle Name:SHALEA
Last Name:ADDISON
Suffix:
Gender:F
Credentials:LPC
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 1263
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:TX
Mailing Address - Zip Code:79360-1263
Mailing Address - Country:US
Mailing Address - Phone:432-955-7019
Mailing Address - Fax:
Practice Address - Street 1:102 SE AVENUE B
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:TX
Practice Address - Zip Code:79360-4434
Practice Address - Country:US
Practice Address - Phone:432-955-7019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional