Provider Demographics
NPI:1710043716
Name:FISHMAN, SHAWNA (LMFT)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:FISHMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:BETH
Other - Last Name:FISHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2512 GRAND AVE UNIT 206
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4121
Mailing Address - Country:US
Mailing Address - Phone:970-310-1747
Mailing Address - Fax:
Practice Address - Street 1:2512 GRAND AVE UNIT 206
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4121
Practice Address - Country:US
Practice Address - Phone:970-310-1747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT.0001280106H00000X
CA33408106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist