MEDICARE: MRS. SHANNON ALISON HARTMAN-WILSON MA, 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
1	106H00000X	Marriage & Family Therapist	39135	CA
2	106H00000X	Marriage & Family Therapist	963	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	135JJ	OTHER	NC	BLUECROSS BLUESHIELD

General Provider Information

NPI Number	:	1447294061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANNON ALISON HARTMAN-WILSON MA, LMFT,

Provider Business Mailing Address
First Line	:	29 CAMP SHOAL DR
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-0642
Country	:	US
Telephone Number	:	850-608-9108
Fax Number	:

Provider Business Practice Location Address
First Line	:	5410 EAST 30A
Second Line	:	SUITE 212
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459
Country	:	US
Telephone Number	:	850-607-9108
Fax Number	:

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	10/14/2025

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