MEDICARE: ASHLEY LYNNE SHANNON

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		MI

General Provider Information

NPI Number	:	1922962943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY LYNNE SHANNON

Provider Business Mailing Address
First Line	:	419 W SAGINAW ST
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-2610
Country	:	US
Telephone Number	:	517-648-4659
Fax Number	:	517-648-4659

Provider Business Practice Location Address
First Line	:	6920 S CEDAR ST STE 8
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48911-6924
Country	:	US
Telephone Number	:	517-648-4659
Fax Number	:

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

Provider Enumeration Date	:	12/13/2025
Last Update Date	:	12/13/2025

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Directions to “ ASHLEY LYNNE SHANNON ” Practice Location

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