Healthcare Provider Details
I. General information
NPI: 1417555129
Provider Name (Legal Business Name): SHANNON WATSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 10/14/2020
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:
III. Provider practice location address
613 NATIONAL AVE
TERRYTOWN LA
70056-2907
US
IV. Provider business mailing address
613 NATIONAL AVE
TERRYTOWN LA
70056-2907
US
V. Phone/Fax
- Phone: 504-606-7416
- Fax:
- Phone: 504-606-7416
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 261QM0801X |
| Taxonomy | Mental Health Clinic/Center (Including Community Mental Health Center) |
| License Number | 7511 |
| License Number State | LA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101Y00000X |
| Taxonomy | Counselor |
| License Number | 7511 |
| License Number State | LA |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Counselor |
| License Number | 7511 |
| License Number State | LA |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YM0800X |
| Taxonomy | Mental Health Counselor |
| License Number | 7511 |
| License Number State | LA |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YP2500X |
| Taxonomy | Professional Counselor |
| License Number | 7511 |
| License Number State | LA |
| # 6 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 104100000X |
| Taxonomy | Social Worker |
| License Number | 7511 |
| License Number State | LA |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1041S0200X |
| Taxonomy | School Social Worker |
| License Number | 7511 |
| License Number State | LA |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 106H00000X |
| Taxonomy | Marriage & Family Therapist |
| License Number | 7511 |
| License Number State | LA |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 171000000X |
| Taxonomy | Military Health Care Provider |
| License Number | 7511 |
| License Number State | LA |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103K00000X |
| Taxonomy | Behavior Analyst |
| License Number | 7511 |
| License Number State | LA |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 171M00000X |
| Taxonomy | Case Manager/Care Coordinator |
| License Number | 7511 |
| License Number State | LA |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 174H00000X |
| Taxonomy | Health Educator |
| License Number | 7511 |
| License Number State | LA |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 102L00000X |
| Taxonomy | Psychoanalyst |
| License Number | 7511 |
| License Number State | LA |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 106S00000X |
| Taxonomy | Behavior Technician |
| License Number | 7511 |
| License Number State | LA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
