MEDICARE: SHANNON LITTLE MA, APCC

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	4532	CA

General Provider Information

NPI Number	:	1962996678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON LITTLE MA, APCC

Provider Business Mailing Address
First Line	:	1525 W LEWIS ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-1220
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1525 W LEWIS ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-1220
Country	:	US
Telephone Number	:	619-272-6485
Fax Number	:

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

Provider Enumeration Date	:	06/16/2018
Last Update Date	:	06/16/2018

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