Healthcare Provider Details

I. General information

NPI: 1699936518
Provider Name (Legal Business Name): SHANNON NICOLE PRESTON M.A., L.M.H.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 REMINGTON ST
FORT COLLINS CO
80524-3074
US

IV. Provider business mailing address

1627 KNOBBY PINE DR
FORT COLLINS CO
80528-9042
US

V. Phone/Fax

Practice location:
  • Phone: 970-430-6638
  • Fax:
Mailing address:
  • Phone: 850-525-7478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH9330
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: