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NPI Code Detail

MEDICARE: SHANNON MARIE FORD

MEDICARE: SHANNON MARIE FORD
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
1101YA0400XAddiction (Substance Use Disorder) Counselor06917-LNV

General Provider Information

NPI Number : 1609497288
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON MARIE FORD
Provider Business Mailing Address
First Line : 3097 E WARM SPRINGS RD STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89120-3757
Country : US
Telephone Number : 702-291-7482
Fax Number : 702-718-6718
Provider Business Practice Location Address
First Line : 2170 E HARMON AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-7840
Country : US
Telephone Number : 702-794-0100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2020
Last Update Date : 01/05/2026

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