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General NPI Number Information
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NPI Number | 1689148355
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Entity Type | Individual
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Provider Name | MICHAEL SHANNON LCSW
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Gender | Male
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Dates
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Enumeration Date | 01/16/2019
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 6800 OWENSMOUTH AVE STE 160
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City | CANOGA PARK
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State | CA
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Zip | 91303-4255
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Country | US
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Telephone | 213-655-0382
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Fax |
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Provider Business Mailing Address
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Address Line | 6800 OWENSMOUTH AVE STE 160
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City | CANOGA PARK
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State | CA
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Zip | 91303-4255
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Country | US
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Telephone | 213-655-0382
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ASW84215
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 129141
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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