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General NPI Number Information
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NPI Number | 1790457943
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Entity Type | Individual
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Provider Name | SHANNON E PIVONEY LCPC
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Gender | Female
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Dates
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Enumeration Date | 10/05/2021
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 270 W PRAIRIE AVE
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City | DECATUR
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State | IL
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Zip | 62523-1221
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Country | US
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Telephone | 217-816-9071
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Fax |
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Provider Business Mailing Address
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Address Line | 216 STUTELY LN
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City | SPRINGFIELD
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State | IL
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Zip | 62704-5234
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Country | US
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Telephone | 217-816-9071
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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 | 180013924
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License Number State | IL
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