Provider Demographics
NPI:1184005902
Name:DOANE, SHANNON (MA LCPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:DOANE
Suffix:
Gender:F
Credentials:MA LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2291 W BROADWAY ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-2113
Mailing Address - Country:US
Mailing Address - Phone:406-396-3062
Mailing Address - Fax:406-532-1616
Practice Address - Street 1:2291 W BROADWAY ST
Practice Address - Street 2:SUITE 5
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-2113
Practice Address - Country:US
Practice Address - Phone:406-396-3062
Practice Address - Fax:406-532-1616
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSWP-LCPC-LIC-12135101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional