Healthcare Provider Details

I. General information

NPI: 1922962943
Provider Name (Legal Business Name): ASHLEY LYNNE SHANNON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2025
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6920 S CEDAR ST STE 8
LANSING MI
48911-6924
US

IV. Provider business mailing address

419 W SAGINAW ST
EAST LANSING MI
48823-2610
US

V. Phone/Fax

Practice location:
  • Phone: 517-648-4659
  • Fax:
Mailing address:
  • Phone: 517-648-4659
  • Fax: 517-648-4659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: