Provider Demographics
NPI:1295396778
Name:SHAUGHNESSY, REBECCA (MA, MS)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:SHAUGHNESSY
Suffix:
Gender:F
Credentials:MA, MS
Other - Prefix:
Other - First Name:BECKI
Other - Middle Name:
Other - Last Name:SHAUGHNESSY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, MS
Mailing Address - Street 1:1515 12TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-5410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1515 12TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-5410
Practice Address - Country:US
Practice Address - Phone:205-324-6561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health