Healthcare Provider Details

I. General information

NPI: 1578814554
Provider Name (Legal Business Name): SHANNON NICOLE STORY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHANNON NICOLE BECK LPC

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S MEDFORD DR
LUFKIN TX
75901-6260
US

IV. Provider business mailing address

2001 S MEDFORD DR
LUFKIN TX
75901-6260
US

V. Phone/Fax

Practice location:
  • Phone: 936-633-5676
  • Fax: 936-633-5695
Mailing address:
  • Phone: 936-633-5676
  • Fax: 936-633-5695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number67523
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: