Provider Demographics
NPI:1326295007
Name:SHANNON, MELISSA ANNE (LPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:SHANNON
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 1:4721 READING RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-6107
Mailing Address - Country:US
Mailing Address - Phone:513-242-7600
Mailing Address - Fax:
Practice Address - Street 1:9018 CINTI COLUMBUS RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-3565
Practice Address - Country:US
Practice Address - Phone:513-755-8133
Practice Address - Fax:513-755-8185
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC-0800047104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker