Provider Demographics
NPI: | 1417555129 |
---|---|
Name: | WATSON, SHANNON (LCSW) |
Entity Type: | Individual |
Prefix: | |
First Name: | SHANNON |
Middle Name: | |
Last Name: | WATSON |
Suffix: | |
Gender: | F |
Credentials: | LCSW |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 613 NATIONAL AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | TERRYTOWN |
Mailing Address - State: | LA |
Mailing Address - Zip Code: | 70056-2907 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 504-606-7416 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 613 NATIONAL AVE |
Practice Address - Street 2: | |
Practice Address - City: | TERRYTOWN |
Practice Address - State: | LA |
Practice Address - Zip Code: | 70056-2907 |
Practice Address - Country: | US |
Practice Address - Phone: | 504-606-7416 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2020-10-14 |
Last Update Date: | 2021-02-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
LA | 7511 | 101Y00000X, 1041S0200X, 101YA0400X, 101YM0800X, 101YP2500X, 102L00000X, 103K00000X, 106H00000X, 106S00000X, 171000000X, 171M00000X, 174H00000X, 261QM0801X, 104100000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 104100000X | Behavioral Health & Social Service Providers | Social Worker | |
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | |
No | 1041S0200X | Behavioral Health & Social Service Providers | Social Worker | School |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional |
No | 102L00000X | Behavioral Health & Social Service Providers | Psychoanalyst | |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | |
No | 106S00000X | Behavioral Health & Social Service Providers | Behavior Technician | |
No | 171000000X | Other Service Providers | Military Health Care Provider | |
No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | |
No | 174H00000X | Other Service Providers | Health Educator | |
No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |