Provider Demographics
NPI:1215595053
Name:HEATH, SHANNON (PLMHP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:HEATH
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12305 GOLD ST # 5
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2760
Mailing Address - Country:US
Mailing Address - Phone:402-330-2691
Mailing Address - Fax:844-389-5770
Practice Address - Street 1:13520 DISCOVERY DR STE 106
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-3002
Practice Address - Country:US
Practice Address - Phone:402-317-2932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11875101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health