Provider Demographics
NPI:1073806964
Name:STRADER, SHANNON E (MA, LPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:E
Last Name:STRADER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 JULIE RIVERS DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3144
Mailing Address - Country:US
Mailing Address - Phone:281-277-8811
Mailing Address - Fax:281-277-8827
Practice Address - Street 1:402 JULIE RIVERS DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3144
Practice Address - Country:US
Practice Address - Phone:281-277-8811
Practice Address - Fax:281-277-8827
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65814101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health