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NPI Code Detail

MEDICARE: LEAH NAN SHANKS MS, LPCC, NCC, LSC

MEDICARE: LEAH NAN SHANKS MS, LPCC, NCC, LSC
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 Counselor2939MN

General Provider Information

NPI Number : 1619537537
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEAH NAN SHANKS MS, LPCC, NCC, LSC
Provider Business Mailing Address
First Line : 7400 METRO BLVD STE 227
Second Line :
City : EDINA
State : MN
Zip : 55439-2470
Country : US
Telephone Number : 612-712-5244
Fax Number :
Provider Business Practice Location Address
First Line : 7400 METRO BLVD STE 227
Second Line :
City : EDINA
State : MN
Zip : 55439-2470
Country : US
Telephone Number : 612-712-5244
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2019
Last Update Date : 01/25/2026

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Directions to “ LEAH NAN SHANKS MS, LPCC, NCC, LSC” Practice Location

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