Provider Demographics
NPI:1285646232
Name:FLETCHER, SHANNON LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LYNN
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4219
Mailing Address - Country:US
Mailing Address - Phone:940-322-2372
Mailing Address - Fax:940-322-3578
Practice Address - Street 1:1800 ROSE ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4219
Practice Address - Country:US
Practice Address - Phone:940-322-2372
Practice Address - Fax:940-322-3578
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60380101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX9447452OtherPHCS
TX180278701Medicaid
TX7490844OtherAETNA BEHAVIORAL HEALTH
TX180278702Medicaid
TX7345LCOtherBCBS OF TEXAS