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General NPI Number Information
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NPI Number | 1881837532
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Entity Type | Individual
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Provider Name | SHANNON NICOLE KAUFMAN LCSW, PMH-C
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Gender | Female
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Dates
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Enumeration Date | 04/10/2009
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Last Update Date | 07/27/2021
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Provider Practice Location Address
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Address Line | 919 N WEBER ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-2976
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Country | US
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Telephone | 719-425-7750
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Fax |
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Provider Business Mailing Address
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Address Line | 2421 N EL PASO ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-7020
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Country | US
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Telephone | 719-213-5753
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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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 | CSW.09924468
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License Number State | CO
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