Provider Demographics
NPI:1396834735
Name:WHITE, SHANNON MICHELLE (LPC)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:MICHELLE
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:MICHELLE
Other - Last Name:PEDDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1818 SAN PEDRO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-3603
Mailing Address - Country:US
Mailing Address - Phone:210-733-3349
Mailing Address - Fax:210-733-7755
Practice Address - Street 1:1818 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-3603
Practice Address - Country:US
Practice Address - Phone:210-733-3349
Practice Address - Fax:210-733-7755
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19270101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor