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General NPI Number Information
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NPI Number | 1972676963
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Entity Type | Individual
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Provider Name | SHANNON LARRY SUMRALL LPC
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Gender | Male
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 234 HIGHWAY 28 W
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City | LAUREL
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State | MS
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Zip | 39443-7845
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Country | US
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Telephone | 504-224-7651
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Fax | 601-729-9002
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Provider Business Mailing Address
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Address Line | 861 SCR 3
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City | TAYLORSVILLE
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State | MS
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Zip | 39168-5066
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Country | US
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Telephone | 504-648-7036
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Fax | 601-729-9002
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 19687
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License Number State | TX
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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 | 3254
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3109
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License Number State | LA
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