Provider Demographics
NPI:1447779483
Name:HENRY, SHANNON (LMHP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NE
Mailing Address - Zip Code:68456-0187
Mailing Address - Country:US
Mailing Address - Phone:402-534-2321
Mailing Address - Fax:402-534-2291
Practice Address - Street 1:1301 CENTENNIAL AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NE
Practice Address - Zip Code:68456-6168
Practice Address - Country:US
Practice Address - Phone:402-534-2321
Practice Address - Fax:402-534-2291
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2615101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health