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General NPI Number Information
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NPI Number | 1528140498
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Entity Type | Individual
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Provider Name | SHANNON MCGUIRE PSYD
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Gender | Female
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 03/07/2022
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Provider Practice Location Address
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Address Line | 7250 CLEARVISTA DR STE 210
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-4643
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Country | US
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Telephone | 317-621-5719
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Fax |
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Provider Business Mailing Address
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Address Line | 6626 E 75TH ST STE 500
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2890
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Country | US
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Telephone | 317-421-2207
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Fax | 317-421-2208
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 20042172A
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License Number State | IN
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