MEDICARE: SHANNON RAE SHIRLEY MS, LCPC, LAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LAC-LAC-LIC-1406	MT
2	101YP2500X	Professional Counselor	SWP-LCPC-LIC-2435	MT

General Provider Information

NPI Number	:	1851789465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON RAE SHIRLEY MS, LCPC, LAC

Provider Business Mailing Address
First Line	:	1042 N 29TH ST
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59101-0730
Country	:	US
Telephone Number	:	406-255-8481
Fax Number	:	406-657-3735

Provider Business Practice Location Address
First Line	:	1042 N 29TH ST
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59101-0730
Country	:	US
Telephone Number	:	406-255-8481
Fax Number	:	406-657-3735

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

Provider Enumeration Date	:	01/05/2015
Last Update Date	:	01/05/2015

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