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General NPI Number Information
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NPI Number | 1114326576
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Entity Type | Organization
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Legal Business Name | SHANNON COON BSN
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Dates
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Enumeration Date | 08/21/2014
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Last Update Date | 08/21/2014
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Provider Practice Location Address
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Address Line | 1474 BLOOMFIELD RD
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City | SEBASTOPOL
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State | CA
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Zip | 95472-5511
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Country | US
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Telephone | 707-823-0848
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Fax |
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Provider Business Mailing Address
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Address Line | 1474 BLOOMFIELD RD
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City | SEBASTOPOL
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State | CA
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Zip | 95472-5511
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Country | US
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Telephone | 707-823-0848
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Fax |
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Authorized Official
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Title or Position | BEHAVIORAL HEALTH SPECIALISTS
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Name | MS. SHANNON A COON
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Credential | BSN
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Telephone | 707-823-0848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 485610
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License Number State | CA
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