Provider Demographics
NPI:1275637613
Name:HUNTER, SHANNON ANN (LPCS, LCDC)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:ANN
Last Name:HUNTER
Suffix:
Gender:F
Credentials:LPCS, LCDC
Other - Prefix:DR
Other - First Name:SHANNON
Other - Middle Name:ANN
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCS
Mailing Address - Street 1:6628 SHADYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-5655
Mailing Address - Country:US
Mailing Address - Phone:409-927-0944
Mailing Address - Fax:
Practice Address - Street 1:6628 SHADYVIEW DR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-5655
Practice Address - Country:US
Practice Address - Phone:409-927-0944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18861101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173894001Medicaid