Provider Demographics
NPI:1053486340
Name:MOYER, SHANNON KAY (MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:KAY
Last Name:MOYER
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:MS
Other - First Name:SHANNON
Other - Middle Name:KAY
Other - Last Name:STRUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:355 N 21ST ST STE 208
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-3707
Mailing Address - Country:US
Mailing Address - Phone:717-412-0245
Mailing Address - Fax:
Practice Address - Street 1:355 N 21ST ST STE 208
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-3707
Practice Address - Country:US
Practice Address - Phone:717-766-0935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0084291101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health