Healthcare Provider Details

I. General information

NPI: 1144142266
Provider Name (Legal Business Name): SHANNON LAVENTURE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S MAIN ST
HERKIMER NY
13350-2375
US

IV. Provider business mailing address

189 OLD FORGE RD
ILION NY
13357-4201
US

V. Phone/Fax

Practice location:
  • Phone: 315-717-0189
  • Fax: 315-717-0289
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number016297
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: