Healthcare Provider Details

I. General information

NPI: 1184930273
Provider Name (Legal Business Name): SHANNON MARIE MORRILL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHANNON MARIE HAASKEN LPC

II. Dates (important events)

Enumeration Date: 08/26/2010
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 N 20TH AVE
PHOENIX AZ
85015-5124
US

IV. Provider business mailing address

4220 N 20TH AVE
PHOENIX AZ
85015-5124
US

V. Phone/Fax

Practice location:
  • Phone: 602-889-9401
  • Fax: 602-889-9404
Mailing address:
  • Phone: 602-889-9401
  • Fax: 602-889-9404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: