Provider Demographics
NPI:1275950693
Name:SHANNON DEETS COUNSELING LLC
Entity Type:Organization
Organization Name:SHANNON DEETS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:DEETS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:814-807-0487
Mailing Address - Street 1:898 PARK AVE
Mailing Address - Street 2:SUITE 16
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3335
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:898 PARK AVE
Practice Address - Street 2:SUITE 16
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3335
Practice Address - Country:US
Practice Address - Phone:814-807-0487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004908101YP2500X
PACW003132L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1912153289OtherNPI
PA1024531890002Medicaid
1205938008OtherNPI
PA231851TVHMedicare PIN