Healthcare Provider Details

I. General information

NPI: 1881104966
Provider Name (Legal Business Name): SHANNON E O'NEILL LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 GIRARD BLVD NE
ALBUQUERQUE NM
87106-1718
US

IV. Provider business mailing address

1721 GIRARD BLVD NE
ALBUQUERQUE NM
87106-1718
US

V. Phone/Fax

Practice location:
  • Phone: 505-819-3350
  • Fax:
Mailing address:
  • Phone: 505-819-3350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCTB20260731
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB20220935
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: