Healthcare Provider Details

I. General information

NPI: 1972205177
Provider Name (Legal Business Name): SHANNON CAUSEY MS, LPC, LCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W MCDERMOTT DR STE 111
ALLEN TX
75013-2751
US

IV. Provider business mailing address

102 WINDSONG WAY
ALLEN TX
75002-1653
US

V. Phone/Fax

Practice location:
  • Phone: 972-369-9830
  • Fax:
Mailing address:
  • Phone: 972-369-9830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15660
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number85183
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: