Healthcare Provider Details

I. General information

NPI: 1265007140
Provider Name (Legal Business Name): SHANNON NOON, LCPC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 FAIRVIEW AVE STE 235
MISSOULA MT
59801-7821
US

IV. Provider business mailing address

1515 FAIRVIEW AVE STE 235
MISSOULA MT
59801-7821
US

V. Phone/Fax

Practice location:
  • Phone: 406-532-1573
  • Fax: 406-532-1541
Mailing address:
  • Phone: 406-532-1573
  • Fax: 406-532-1541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: SHANNON JOY NOON
Title or Position: LICENSED CLINICAL PROFESSIONAL COUN
Credential: LCPC
Phone: 406-532-1573