MEDICARE: SHANNON HAYES LCPC-CC

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
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1194613547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON HAYES LCPC-CC

Provider Business Mailing Address
First Line	:	225 MAIN ST UNIT 1665
Second Line	:
City	:	SACO
State	:	ME
Zip	:	04072-7060
Country	:	US
Telephone Number	:	774-231-8278
Fax Number	:

Provider Business Practice Location Address
First Line	:	69 YORK ST STE 4
Second Line	:
City	:	KENNEBUNK
State	:	ME
Zip	:	04043-7186
Country	:	US
Telephone Number	:	774-231-8278
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2025
Last Update Date	:	06/25/2025

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