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NPI Code Detail

MEDICARE: SHANNON RENEE CAMPBELL

MEDICARE: SHANNON RENEE CAMPBELL
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
1101YP2500XProfessional Counselor83375TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
183375OTHERTXLPC LICENSE

General Provider Information

NPI Number : 1174246839
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON RENEE CAMPBELL
Provider Business Mailing Address
First Line : PO BOX 38
Second Line :
City : DAYTON
State : TX
Zip : 77535-0001
Country : US
Telephone Number : 936-262-7800
Fax Number :
Provider Business Practice Location Address
First Line : 104 W CLAYTON ST
Second Line :
City : DAYTON
State : TX
Zip : 77535-2241
Country : US
Telephone Number : 936-262-7800
Fax Number : 281-899-5295
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2022
Last Update Date : 06/23/2025

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Directions to “ SHANNON RENEE CAMPBELL ” Practice Location

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