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General NPI Number Information
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NPI Number | 1336616739
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Entity Type | Individual
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Provider Name | MICHELLE SHANNON MS, LPC
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Gender | Female
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Dates
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Enumeration Date | 10/24/2018
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Last Update Date | 10/24/2018
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Provider Practice Location Address
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Address Line | 5601 DEMOCRACY DR STE 135
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City | PLANO
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State | TX
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Zip | 75024-3672
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Country | US
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Telephone | 469-301-4831
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Fax |
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Provider Business Mailing Address
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Address Line | 3606 RIDGESTONE DR
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City | GARLAND
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State | TX
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Zip | 75040-3598
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Country | US
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Telephone | 214-762-7990
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 71861
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License Number State | TX
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