MEDICARE: SHAWN PANTALIONO M.S., ED.S., LPCC-S

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	101Y00000X	Counselor	127774	KY
2	101YP2500X	Professional Counselor	245129	KY

General Provider Information

NPI Number	:	1508049768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN PANTALIONO M.S., ED.S., LPCC-S

Provider Business Mailing Address
First Line	:	301 BEACON HL
Second Line	:
City	:	VERSAILLES
State	:	KY
Zip	:	40383-1247
Country	:	US
Telephone Number	:	859-321-0335
Fax Number	:

Provider Business Practice Location Address
First Line	:	713 MILLPOND RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40514-1570
Country	:	US
Telephone Number	:	859-309-2877
Fax Number	:

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

Provider Enumeration Date	:	12/11/2007
Last Update Date	:	04/27/2022

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