Basic Information
| Provider Information | |||||||||
| NPI: | 1154378727 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEABOURN | ||||||||
| FirstName: | SHANE | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6651 SPARROWOOD DR | ||||||||
| Address2: | |||||||||
| City: | OAKLANDON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462368126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9189612272 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5638 PROFESSIONAL CIR | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462415042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172478900 | ||||||||
| FaxNumber: | 3172478935 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2006 | ||||||||
| LastUpdateDate: | 01/04/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 34006606A | IN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.