Provider Demographics
NPI:1417027079
Name:MCCLARD, SHANNON (MA, LPE)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:MCCLARD
Suffix:
Gender:F
Credentials:MA, LPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 AUTUMNRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-7146
Mailing Address - Country:US
Mailing Address - Phone:501-760-8333
Mailing Address - Fax:501-463-5004
Practice Address - Street 1:100 RIDGEWAY ST STE 1
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-7155
Practice Address - Country:US
Practice Address - Phone:501-760-8333
Practice Address - Fax:501-623-2266
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR96-22EI103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling