MEDICARE: MRS. SHANNON RENEE WRIGHT 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	390200000X	Student in an Organized Health Care Education/Training Program
2	101YM0800X	Mental Health Counselor	E.2001763-SUPV	OH

General Provider Information

NPI Number	:	1841734951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANNON RENEE WRIGHT LPCC-S

Provider Business Mailing Address
First Line	:	6394 BREEZEHILL RD SW
Second Line	:
City	:	EAST SPARTA
State	:	OH
Zip	:	44626-9402
Country	:	US
Telephone Number	:	330-432-2182
Fax Number	:

Provider Business Practice Location Address
First Line	:	37303 HARVEST AVE
Second Line	:
City	:	AVON
State	:	OH
Zip	:	44011-2803
Country	:	US
Telephone Number	:	440-847-8505
Fax Number	:

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

Provider Enumeration Date	:	12/08/2016
Last Update Date	:	07/17/2023

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