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NPI Code Detail

MEDICARE: SHANNON BAROUSSE LMFT

MEDICARE: SHANNON BAROUSSE LMFT
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
1101YP2500XProfessional CounselorLMFT-10649AZ

General Provider Information

NPI Number : 1326737560
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON BAROUSSE LMFT
Provider Business Mailing Address
First Line : 7565 E EAGLE CREST DR STE 201
Second Line :
City : MESA
State : AZ
Zip : 85207-1067
Country : US
Telephone Number : 480-788-5069
Fax Number :
Provider Business Practice Location Address
First Line : 7565 E EAGLE CREST DR STE 201
Second Line :
City : MESA
State : AZ
Zip : 85207-1067
Country : US
Telephone Number : 480-788-5069
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2023
Last Update Date : 05/03/2023

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Directions to “ SHANNON BAROUSSE LMFT” Practice Location

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