MEDICARE: SHANNON VINCENT

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1255125373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON VINCENT

Provider Business Mailing Address
First Line	:	1400 MCKINNEY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77010-4023
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 MCKINNEY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77010-4023
Country	:	US
Telephone Number	:	832-629-3099
Fax Number	:

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

Provider Enumeration Date	:	04/04/2025
Last Update Date	:	04/04/2025

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Directions to “ SHANNON VINCENT ” Practice Location

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