Provider Demographics
NPI:1184864712
Name:WILLIAMS, SHANNON LEE (MA, PLPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MA, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-3301
Mailing Address - Country:US
Mailing Address - Phone:417-588-5885
Mailing Address - Fax:417-588-4296
Practice Address - Street 1:104 CRESCENT DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-3301
Practice Address - Country:US
Practice Address - Phone:417-588-5885
Practice Address - Fax:417-588-4296
Is Sole Proprietor?:No
Enumeration Date:2009-02-22
Last Update Date:2009-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009004310101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2009004310OtherPROVISIONAL LICENSE PROFESSIONAL COUNSELOR