Provider Demographics
NPI:1265643894
Name:MARRIOTT, SHANNON R (MA, LPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:R
Last Name:MARRIOTT
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5945 W PARKER RD
Mailing Address - Street 2:APT. 434
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7755
Mailing Address - Country:US
Mailing Address - Phone:972-932-5995
Mailing Address - Fax:
Practice Address - Street 1:4031 W PLANO PKWY
Practice Address - Street 2:SUITE 211
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5619
Practice Address - Country:US
Practice Address - Phone:214-351-3490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61175101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional