MEDICARE: SHANNON EILEEN JUNG MA, LCPC

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	101YM0800X	Mental Health Counselor	CP0016	NV

General Provider Information

NPI Number	:	1285331074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON EILEEN JUNG MA, LCPC

Provider Business Mailing Address
First Line	:	801 ROSEBERRY DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-7559
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 ROSEBERRY DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-7559
Country	:	US
Telephone Number	:	414-750-6954
Fax Number	:

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

Provider Enumeration Date	:	02/13/2023
Last Update Date	:	02/13/2023

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