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NPI Code Detail

MEDICARE: SHANNON E STRADER M.A., L.P.C.

MEDICARE: SHANNON E STRADER M.A., L.P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor65814TX

General Provider Information

NPI Number : 1073806964
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON E STRADER M.A., L.P.C.
Provider Business Mailing Address
First Line : 402 JULIE RIVERS DR
Second Line :
City : SUGAR LAND
State : TX
Zip : 77478-3144
Country : US
Telephone Number : 281-277-8811
Fax Number : 281-277-8827
Provider Business Practice Location Address
First Line : 402 JULIE RIVERS DR
Second Line :
City : SUGAR LAND
State : TX
Zip : 77478-3144
Country : US
Telephone Number : 281-277-8811
Fax Number : 281-277-8827
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2011
Last Update Date : 05/25/2011

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