Healthcare Provider Details

I. General information

NPI: 1053486340
Provider Name (Legal Business Name): SHANNON KAY MOYER MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON KAY STRUCK LMFT

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 N 12TH ST STE 101
LEMOYNE PA
17043-1225
US

IV. Provider business mailing address

635 N 12TH ST STE 101
LEMOYNE PA
17043-1225
US

V. Phone/Fax

Practice location:
  • Phone: 717-412-0245
  • Fax: 717-510-6704
Mailing address:
  • Phone: 717-412-0245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMF001189
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: