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General NPI Number Information
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NPI Number | 1043561806
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Entity Type | Individual
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Provider Name | SHANNON MARIE THOMAS
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Gender | Female
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 09/19/2012
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Provider Practice Location Address
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Address Line | 494 SHERIDAN BLVD
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City | LAKEWOOD
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State | CO
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Zip | 80226-8106
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Country | US
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Telephone | 303-974-5764
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Fax |
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Provider Business Mailing Address
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Address Line | 565 E 77TH AVE
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City | THORNTON
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State | CO
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Zip | 80229-1821
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Country | US
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Telephone | 303-862-2210
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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