Healthcare Provider Details

I. General information

NPI: 1437638392
Provider Name (Legal Business Name): SHANNON DENNY M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2018
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 S MAYFLOWER AVE
MONROVIA CA
91016-3336
US

IV. Provider business mailing address

12277 APPLE VALLEY RD # 116
APPLE VALLEY CA
92308-1701
US

V. Phone/Fax

Practice location:
  • Phone: 626-394-1423
  • Fax:
Mailing address:
  • Phone: 626-394-1423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT45493
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: