Provider Demographics
NPI:1093064453
Name:O'HARA, SHANNON (LMHC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:O'HARA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:RIBNEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:8180 CLEARVISTA PARKWAY
Mailing Address - Street 2:SUITE 230
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-4649
Mailing Address - Country:US
Mailing Address - Phone:317-621-7561
Mailing Address - Fax:317-355-6096
Practice Address - Street 1:6950 HILLSDALE CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2040
Practice Address - Country:US
Practice Address - Phone:317-621-7740
Practice Address - Fax:317-621-7608
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001412A101YS0200X
IN87000623A101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool