MEDICARE: SHANNON NAHARA MA, LPC

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	101YP2500X	Professional Counselor	6401017134	MI

General Provider Information

NPI Number	:	1649739079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON NAHARA MA, LPC

Provider Business Mailing Address
First Line	:	33 ANDERSON CT
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49017-3854
Country	:	US
Telephone Number	:	720-469-0644
Fax Number	:

Provider Business Practice Location Address
First Line	:	72 NORTH AVE
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49017-3415
Country	:	US
Telephone Number	:	720-469-0644
Fax Number	:

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

Provider Enumeration Date	:	03/15/2019
Last Update Date	:	05/06/2025

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