Healthcare Provider Details

I. General information

NPI: 1407773617
Provider Name (Legal Business Name): SHANNON CAROLLO TVI, COMS, M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 GUMWOOD ST
GREAT FALLS MT
59405-7925
US

IV. Provider business mailing address

807 GUMWOOD ST
GREAT FALLS MT
59405
US

V. Phone/Fax

Practice location:
  • Phone: 406-401-5172
  • Fax:
Mailing address:
  • Phone: 406-401-5172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225CX0006X
TaxonomyOrientation and Mobility Training Rehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: