MEDICARE: SHANNON PURTELL LATTIMORE LPC SUPERVISOR

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	17152	TX

General Provider Information

NPI Number	:	1932118742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON PURTELL LATTIMORE LPC SUPERVISOR

Provider Business Mailing Address
First Line	:	4801 FRANKFORD RD STE 300
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75287-5329
Country	:	US
Telephone Number	:	469-620-6860
Fax Number	:

Provider Business Practice Location Address
First Line	:	9304 FOREST LN
Second Line	:	#100 SOUTH
City	:	DALLAS
State	:	TX
Zip	:	75243-6238
Country	:	US
Telephone Number	:	214-340-0208
Fax Number	:	214-340-7092

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	02/28/2024

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Directions to “ SHANNON PURTELL LATTIMORE LPC SUPERVISOR” Practice Location

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