Healthcare Provider Details

I. General information

NPI: 1629683651
Provider Name (Legal Business Name): SHANNON MCQUAID LMFT LISAC CSAT CDWF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23222 N CHURCH RD
SCOTTSDALE AZ
85255-3737
US

IV. Provider business mailing address

PO BOX 14164
SCOTTSDALE AZ
85267-4164
US

V. Phone/Fax

Practice location:
  • Phone: 480-477-7899
  • Fax: 480-477-7894
Mailing address:
  • Phone: 480-477-7899
  • Fax: 480-477-7894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLISAC-1596
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT-10032
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: