MEDICARE: SHANAN SPENCER LCPC

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	86645	TX
2	101YP2500X	Professional Counselor	LC2763	MD
3	101YM0800X	Mental Health Counselor	86645	TX

General Provider Information

NPI Number	:	1760648836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANAN SPENCER LCPC

Provider Business Mailing Address
First Line	:	1180 PROFESSIONAL CT
Second Line	:
City	:	HAGERSTOWN
State	:	MD
Zip	:	21740-5852
Country	:	US
Telephone Number	:	301-791-3045
Fax Number	:	240-313-3071

Provider Business Practice Location Address
First Line	:	150 PARK AVE
Second Line	:
City	:	FROSTBURG
State	:	MD
Zip	:	21532-2218
Country	:	US
Telephone Number	:	301-689-5034
Fax Number	:	301-689-5036

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

Provider Enumeration Date	:	07/29/2008
Last Update Date	:	09/18/2025

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Directions to “ SHANAN SPENCER LCPC” Practice Location

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