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General NPI Number Information
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NPI Number | 1568550077
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Entity Type | Individual
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Provider Name | SHANNON MOORE JOHNSON LISAC, BA
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Gender | Female
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 04/24/2013
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Provider Practice Location Address
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Address Line | 12033 AGENCY RD STE 730
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City | PARKER
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State | AZ
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Zip | 85344-7718
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Country | US
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Telephone | 928-669-3256
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Fax | 928-669-3252
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Provider Business Mailing Address
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Address Line | 12033 AGENCY RD STE 730
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City | PARKER
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State | AZ
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Zip | 85344-7718
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Country | US
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Telephone | 928-669-3256
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Fax | 928-669-3252
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LISAC0725
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License Number State |
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