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General NPI Number Information
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NPI Number | 1639592843
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Entity Type | Individual
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Provider Name | SHANNON L DEITCH LPC
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Gender | Female
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Dates
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Enumeration Date | 01/23/2014
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Last Update Date | 12/27/2016
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Provider Practice Location Address
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Address Line | 105 N GORDON ST SUITE 202
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City | ALVIN
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State | TX
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Zip | 77511-2718
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Country | US
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Telephone | 281-585-0000
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Fax | 281-585-0080
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Provider Business Mailing Address
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Address Line | 3913 SPRING CIRCLE DR E
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City | PEARLAND
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State | TX
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Zip | 77584-9385
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Country | US
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Telephone | 281-788-6807
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 66956
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 66956
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License Number State | TX
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