MEDICARE: SHANNON LEE MA, LPC ASSOCIATE

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	101YM0800X	Mental Health Counselor	97498	TX

General Provider Information

NPI Number	:	1720886955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON LEE MA, LPC ASSOCIATE

Provider Business Mailing Address
First Line	:	5255 ROUND TABLE DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-2827
Country	:	US
Telephone Number	:	210-420-8094
Fax Number	:

Provider Business Practice Location Address
First Line	:	5255 ROUND TABLE DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-2827
Country	:	US
Telephone Number	:	210-420-8094
Fax Number	:

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

Provider Enumeration Date	:	03/04/2025
Last Update Date	:	03/04/2025

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