Provider Demographics
NPI:1164651451
Name:SHANNON, PETER THOMPSON (MS)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:THOMPSON
Last Name:SHANNON
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 HIGH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4192
Mailing Address - Country:US
Mailing Address - Phone:541-683-8438
Mailing Address - Fax:541-485-2059
Practice Address - Street 1:1400 HIGH ST
Practice Address - Street 2:SUITE B
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4192
Practice Address - Country:US
Practice Address - Phone:541-683-8438
Practice Address - Fax:541-485-2059
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLPC#CO132101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional