MEDICARE: SHANNON MIKEAL CARROLL LCSW

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	104100000X	Social Worker	85364	CA

General Provider Information

NPI Number	:	1518440429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON MIKEAL CARROLL LCSW

Provider Business Mailing Address
First Line	:	6500 GREENVILLE AVE STE 430
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-1004
Country	:	US
Telephone Number	:	682-999-0997
Fax Number	:

Provider Business Practice Location Address
First Line	:	6500 GREENVILLE AVE STE 430
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-1004
Country	:	US
Telephone Number	:	682-999-0997
Fax Number	:

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

Provider Enumeration Date	:	09/07/2018
Last Update Date	:	07/01/2026

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