Provider Demographics
NPI:1174817514
Name:LEE, SHANNON (LPC)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 CHAMPION GRANDVIEW WAY
Mailing Address - Street 2:UNIT 28103
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-8223
Mailing Address - Country:US
Mailing Address - Phone:512-694-4375
Mailing Address - Fax:
Practice Address - Street 1:2525 WALLINGWOOD DR
Practice Address - Street 2:BLDG 1, SUITE 124
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6900
Practice Address - Country:US
Practice Address - Phone:512-694-4375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62690101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional