MEDICARE: SHANNON DERING LPC

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
1	101YP2500X	Professional Counselor	PC012197	PA

General Provider Information

NPI Number	:	1134742521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON DERING LPC

Provider Business Mailing Address
First Line	:	258 SPRING RUN RD
Second Line	:
City	:	CRESCENT
State	:	PA
Zip	:	15046-5401
Country	:	US
Telephone Number	:	412-715-8784
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 BRODHEAD RD STE 2
Second Line	:
City	:	MOON TOWNSHIP
State	:	PA
Zip	:	15108-2322
Country	:	US
Telephone Number	:	412-339-1982
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2020
Last Update Date	:	01/13/2023

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