Healthcare Provider Details

I. General information

NPI: 1891095766
Provider Name (Legal Business Name): SHANNON BENNETT LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 JOHNSON DR STE 305
MISSION KS
66205-2920
US

IV. Provider business mailing address

5201 JOHNSON DR STE 305
MISSION KS
66205-2920
US

V. Phone/Fax

Practice location:
  • Phone: 913-653-5962
  • Fax:
Mailing address:
  • Phone: 913-653-5962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2013014283
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2327
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: