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General NPI Number Information
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NPI Number | 1740829092
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Entity Type | Individual
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Provider Name | SHANNA JANE MUIR LCPC
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Gender | Female
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Dates
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Enumeration Date | 01/03/2020
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Last Update Date | 04/19/2023
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Provider Practice Location Address
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Address Line | 4304 W LORA ANN LN
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City | PEORIA
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State | IL
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Zip | 61615-2457
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Country | US
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Telephone | 309-210-6767
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Fax |
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Provider Business Mailing Address
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Address Line | 4304 W LORA ANN LN
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City | PEORIA
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State | IL
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Zip | 61615-2457
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Country | US
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Telephone | 309-210-6767
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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 | 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 #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.014707
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License Number State | IL
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