Provider Demographics
NPI:1225402175
Name:GUERNSEY, SHANNON NICOLE (LCSW)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:NICOLE
Last Name:GUERNSEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:NICOLE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1155 KELLY JOHNSON BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3957
Mailing Address - Country:US
Mailing Address - Phone:719-373-0051
Mailing Address - Fax:719-373-0052
Practice Address - Street 1:1155 KELLY JOHNSON BLVD STE 111
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3957
Practice Address - Country:US
Practice Address - Phone:719-373-0051
Practice Address - Fax:719-373-0052
Is Sole Proprietor?:No
Enumeration Date:2015-11-16
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68800101YM0800X
CO.099257111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health