Provider Demographics
NPI:1407478704
Name:SHANNON MONNIG NELSON, MS, LMFT, CCLS, PLLC
Entity Type:Organization
Organization Name:SHANNON MONNIG NELSON, MS, LMFT, CCLS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MARRIAGE & FAMILY THERAPIS
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:KAE
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT, CCLS, PLLC
Authorized Official - Phone:210-317-2515
Mailing Address - Street 1:6322 SOVEREIGN ST STE 263
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5188
Mailing Address - Country:US
Mailing Address - Phone:210-317-2515
Mailing Address - Fax:
Practice Address - Street 1:6322 SOVEREIGN ST STE 263
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5188
Practice Address - Country:US
Practice Address - Phone:210-317-2515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-11
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty