Provider Demographics
NPI:1346599123
Name:SHANNON, JANET ELIZABETH (LPC)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:ELIZABETH
Last Name:SHANNON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:ELIZABETH
Other - Last Name:O'CONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:8 E COTTONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-6237
Mailing Address - Country:US
Mailing Address - Phone:928-634-2236
Mailing Address - Fax:928-634-8960
Practice Address - Street 1:8 E COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-6237
Practice Address - Country:US
Practice Address - Phone:928-634-2236
Practice Address - Fax:928-634-8960
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-12109101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional