Provider Demographics
NPI:1225537244
Name:STAMPER, SHANON L (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:SHANON
Middle Name:L
Last Name:STAMPER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 CARTER RD
Mailing Address - Street 2:
Mailing Address - City:WHITESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42378-9427
Mailing Address - Country:US
Mailing Address - Phone:270-702-3417
Mailing Address - Fax:
Practice Address - Street 1:2460 CARTER RD
Practice Address - Street 2:
Practice Address - City:WHITESVILLE
Practice Address - State:KY
Practice Address - Zip Code:42378-9427
Practice Address - Country:US
Practice Address - Phone:270-702-3416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY104770101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional