Provider Demographics
NPI:1275937252
Name:SHANNON, PAULA (LMFT, LCADC, LCPC)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:SHANNON
Suffix:
Gender:F
Credentials:LMFT, LCADC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23067
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72221-3067
Mailing Address - Country:US
Mailing Address - Phone:501-352-4178
Mailing Address - Fax:702-442-9615
Practice Address - Street 1:701 RAHLING RD APT 1310
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-5280
Practice Address - Country:US
Practice Address - Phone:501-352-4178
Practice Address - Fax:702-442-9615
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00553-LC101YA0400X
NVCP1217101YM0800X, 101YP2500X
NVMI0880106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV25004789Medicaid
NV71853Medicaid