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NPI Code Detail

MEDICARE: SHANNON EDWARDS

MEDICARE: SHANNON EDWARDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor6974CA
2106H00000XMarriage & Family Therapist151600CA

General Provider Information

NPI Number : 1134622293
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON EDWARDS
Provider Business Mailing Address
First Line : 30131 TOWN CENTER DR STE 135
Second Line :
City : LAGUNA NIGUEL
State : CA
Zip : 92677-2010
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 30131 TOWN CENTER DR STE 135
Second Line :
City : LAGUNA NIGUEL
State : CA
Zip : 92677-2010
Country : US
Telephone Number : 949-594-4455
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2018
Last Update Date : 12/08/2025

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Directions to “ SHANNON EDWARDS ” Practice Location

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