MEDICARE: SHANNON E SMITH LPC, LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1184346702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHANNON E SMITH LPC, LLC

Provider Business Mailing Address
First Line	:	30791 DUNN RD
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-1528
Country	:	US
Telephone Number	:	225-230-9100
Fax Number	:

Provider Business Practice Location Address
First Line	:	3535 S SHERWOOD FOREST BLVD STE 227
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-2255
Country	:	US
Telephone Number	:	225-230-9100
Fax Number	:	225-416-6046

Authorized Official
Title or Position	:	OWNER
Name	:	MS. SHANNON SMITH
Credential	:	LPC
Telephone Number	:	225-230-9100

Provider Enumeration Date	:	09/12/2022
Last Update Date	:	09/19/2022

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