Provider Demographics
NPI:1245570712
Name:ETCHEVERRY, SHANNON MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:MARIE
Last Name:ETCHEVERRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6032 AIRLINE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77076-4210
Mailing Address - Country:US
Mailing Address - Phone:713-970-8612
Mailing Address - Fax:713-970-7246
Practice Address - Street 1:7011 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2007
Practice Address - Country:US
Practice Address - Phone:713-970-7000
Practice Address - Fax:713-970-7246
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX534871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical