Healthcare Provider Details

I. General information

NPI: 1578227310
Provider Name (Legal Business Name): SHANNON LYNN GALVIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151 S VAUGHN WAY STE 660
AURORA CO
80014-3514
US

IV. Provider business mailing address

6767 S VINE ST # 1117
CENTENNIAL CO
80122-3171
US

V. Phone/Fax

Practice location:
  • Phone: 720-722-5950
  • Fax:
Mailing address:
  • Phone: 720-722-5950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0019392
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: