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General NPI Number Information
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NPI Number | 1790431096
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Entity Type | Individual
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Provider Name | SHANNON LATRAY LCPC
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Gender | Female
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Dates
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Enumeration Date | 02/24/2022
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 22 BRIMSTONE ST STE A
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City | BUTTE
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State | MT
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Zip | 59701-4978
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Country | US
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Telephone | 406-560-2799
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Fax |
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Provider Business Mailing Address
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Address Line | 22 BRIMSTONE ST STE A
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City | BUTTE
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State | MT
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Zip | 59701-4978
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Country | US
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Telephone | 406-560-2799
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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 | PRC200001490
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C7145
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 37PC00912400
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License Number State | NJ
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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 | LPC-21627
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License Number State | AZ
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Taxonomy #5
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CC6660
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License Number State | ME
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Taxonomy #6
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 12837764-6004
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License Number State | UT
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Taxonomy #7
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 13387-MH-CC
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License Number State | MA
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Taxonomy #8
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | BBH-LCPC-LIC-17894
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License Number State | MT
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