Provider Demographics
NPI:1174746598
Name:SHEA, PAULA (LCSW)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:SHEA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9501 N CAPITAL OF TEXAS HWY STE 305
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-6374
Mailing Address - Country:US
Mailing Address - Phone:512-340-0980
Mailing Address - Fax:512-535-1198
Practice Address - Street 1:9501 N CAPITAL OF TEXAS HWY
Practice Address - Street 2:STE 305
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-6606
Practice Address - Country:US
Practice Address - Phone:512-340-0980
Practice Address - Fax:512-535-1198
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical